Individual
JASON HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
164 LAKE APOLLO DR, HANNIBAL, MO 63401-2308
(858) 200-5690
Mailing address
PO BOX 1222, HANNIBAL, MO 63401-1222
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT60201832
WA
Other
Enumeration date
05/17/2011
Last updated
05/17/2011
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