Provider Demographics
NPI:1417380916
Name:HENRY, AMANDA RUTH (DPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RUTH
Last Name:HENRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ELDEN ST
Mailing Address - Street 2:STE 242
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4861
Mailing Address - Country:US
Mailing Address - Phone:877-488-1990
Mailing Address - Fax:
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:STE 242
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:877-488-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210839225100000X
TX1231829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist