Provider Demographics
NPI:1407456197
Name:PLANGE, HENRY KOFI JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:KOFI
Last Name:PLANGE
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BENS TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-7000
Mailing Address - Country:US
Mailing Address - Phone:817-514-1544
Mailing Address - Fax:
Practice Address - Street 1:250 BENS TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-7000
Practice Address - Country:US
Practice Address - Phone:817-514-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2114122225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant