Provider Demographics
NPI:1013232206
Name:HENN, DEBRA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:HENN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0251
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:775-883-7742
Practice Address - Street 1:60 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3079
Practice Address - Country:US
Practice Address - Phone:831-786-9000
Practice Address - Fax:831-786-9100
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20496OtherLICENSE