Provider Demographics
NPI:1831209345
Name:MCHENRY, WILLIAM
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MCHENRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BECKETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4806
Mailing Address - Country:US
Mailing Address - Phone:203-255-8888
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE B100
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-268-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005388OtherLICENSE