MEDICARE: MRS. HEATHER LEA HENLEY P.T.

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	PTH4511	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-28489	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1881752087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER LEA HENLEY P.T.

Provider Business Mailing Address
First Line	:	201 GREENSPORT RD
Second Line	:
City	:	ASHVILLE
State	:	AL
Zip	:	35953-5622
Country	:	US
Telephone Number	:	205-594-5592
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 RAINBOW DR
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-5804
Country	:	US
Telephone Number	:	256-413-7422
Fax Number	:	256-442-8106

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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