Provider Demographics
NPI:1043289515
Name:HENRY, JENNIFER DAWN (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:HENRY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 GOSLING DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2726
Mailing Address - Country:US
Mailing Address - Phone:732-979-8189
Mailing Address - Fax:
Practice Address - Street 1:3400 HORIZON DR STE 110
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2675
Practice Address - Country:US
Practice Address - Phone:610-277-6447
Practice Address - Fax:610-277-8244
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist