Provider Demographics
NPI:1164553087
Name:HENRY, KATHLEEN RAFTIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:RAFTIS
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:LOUISE
Other - Last Name:RAFTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 SOPHIE LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-4423
Mailing Address - Country:US
Mailing Address - Phone:603-661-6953
Mailing Address - Fax:603-346-4646
Practice Address - Street 1:5 SOPHIE LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-4423
Practice Address - Country:US
Practice Address - Phone:603-661-6953
Practice Address - Fax:603-346-4646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y002763NH01OtherANTHEM BLUE CROSS
HERE5787Medicare ID - Type Unspecified