Provider Demographics
NPI:1750671053
Name:HENLY, REBECCA S (MSPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:HENLY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GREY DOVE DR.
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317
Mailing Address - Country:US
Mailing Address - Phone:610-247-8994
Mailing Address - Fax:
Practice Address - Street 1:20 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3058
Practice Address - Country:US
Practice Address - Phone:610-518-9100
Practice Address - Fax:610-518-0992
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005308L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor