Individual
MARK W HENEBRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
108 PROFESSIONAL PARKWAY DR., TROY, MO 63379-2823
(636) 528-6080
(636) 528-3973
Mailing address
108 PROFESSIONAL PARKWAY DR., TROY, MO 63379-2823
(636) 528-6080
(636) 528-3973
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070017005
IL
225100000X
Physical Therapist
2009002205
MO
225100000X
Physical Therapist
Primary
2009004293
MO
Other
Enumeration date
02/03/2009
Last updated
04/21/2009
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