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General NPI Number Information
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NPI Number | 1699797829
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Entity Type | Individual
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Provider Name | MARK DAVID HENRICH PT,MBA
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 100 TRACY WAY
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City | CHARLESTON
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State | WV
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Zip | 25311-1257
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Country | US
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Telephone | 304-343-4583
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Fax | 304-343-9207
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Provider Business Mailing Address
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Address Line | 100 TRACY WAY
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City | CHARLESTON
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State | WV
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Zip | 25311-1257
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Country | US
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Telephone | 304-343-4583
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Fax | 304-343-9207
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1358
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License Number State | WV
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