MEDICARE: MS. PAULA DENISE HENRY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05003827A	IN

General Provider Information

NPI Number	:	1306814645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA DENISE HENRY PT

Provider Business Mailing Address
First Line	:	5851 S MEEKER AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47302
Country	:	US
Telephone Number	:	765-286-1871
Fax Number	:	765-741-8219

Provider Business Practice Location Address
First Line	:	3607 NORTH EVERBROOK LANE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304
Country	:	US
Telephone Number	:	765-741-8390
Fax Number	:	765-741-8219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	07/08/2007

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