Provider Demographics
NPI:1205234473
Name:HENRY, NANCY E M (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:E M
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ELLEN
Other - Last Name:MOLITOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5412 NW 122ND TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1829
Mailing Address - Country:US
Mailing Address - Phone:913-235-8885
Mailing Address - Fax:
Practice Address - Street 1:10944 NW EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8214
Practice Address - Country:US
Practice Address - Phone:405-924-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1101862225100000X
OK5438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20806560AMedicaid