MEDICARE: KATHLEEN HENRY PT, DPT

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	2251P0200X	Pediatric Physical Therapist	070017402	IL
2	2251P0200X	Pediatric Physical Therapist	1311853	TX

General Provider Information

NPI Number	:	1982830444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN HENRY PT, DPT

Provider Business Mailing Address
First Line	:	115 SANDRA MURAIDA WAY APT 518
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-4840
Country	:	US
Telephone Number	:	248-819-0771
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 SANDRA MURAIDA WAY APT 518
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-4840
Country	:	US
Telephone Number	:	248-819-0771
Fax Number	:

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	07/02/2020

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