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General NPI Number Information
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NPI Number | 1972084689
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Entity Type | Individual
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Provider Name | JOHN MCHENRY DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 15884 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2208
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Country | US
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Telephone | 636-220-9335
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Fax |
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Provider Business Mailing Address
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Address Line | 4814 EICHELBERGER ST
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City | SAINT LOUIS
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State | MO
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Zip | 63116-1230
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Country | US
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Telephone | 314-681-7055
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2018028606
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License Number State | MO
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