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NPI Code Detail

MEDICARE: KADESHA HENRY

MEDICARE: KADESHA HENRY
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
1225100000XPhysical Therapist
2225100000XPhysical TherapistPT028686PA

General Provider Information

NPI Number : 1346852027
Entity Type Code : Individual
Provider Name (Legal Business Name) : KADESHA HENRY
Provider Business Mailing Address
First Line : 232 SHERBROOK BLVD
Second Line :
City : UPPER DARBY
State : PA
Zip : 19082-4607
Country : US
Telephone Number : 610-931-5630
Fax Number :
Provider Business Practice Location Address
First Line : 2004 OLD ARCH RD
Second Line :
City : NORRISTOWN
State : PA
Zip : 19401-2008
Country : US
Telephone Number : 610-277-0380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2020
Last Update Date : 08/24/2020

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