Provider Demographics
NPI:1982830444
Name:HENRY, KATHLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:115 SANDRA MURAIDA WAY APT 518
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4840
Mailing Address - Country:US
Mailing Address - Phone:248-819-0771
Mailing Address - Fax:
Practice Address - Street 1:115 SANDRA MURAIDA WAY APT 518
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4840
Practice Address - Country:US
Practice Address - Phone:248-819-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700174022251P0200X
TX13118532251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics