Provider Demographics
NPI:1376532622
Name:MCHENRY, TIMOTHY P (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:125 HARTMAN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6463
Practice Address - Country:US
Practice Address - Phone:724-836-6620
Practice Address - Fax:724-836-1268
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP71050Medicare UPIN
069551Medicare ID - Type Unspecified