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General NPI Number Information
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NPI Number | 1417701848
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Entity Type | Individual
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Provider Name | BRIANA HENTHORNE PTA
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Gender | Female
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | C 1722 TAGATY ST
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City | FT. LIBERTY
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State | NC
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Zip | 28307
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Country | US
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Telephone | 910-907-6872
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Fax |
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Provider Business Mailing Address
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Address Line | 115 GROVER PL
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City | CAMERON
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State | NC
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Zip | 28326-6212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A7524
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License Number State | NC
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