Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 28362 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT28362 | CA |
NPI | 1083855498 |
---|---|
Provider Name | Mrs. Joanne A Henze |
First Address | Bishop, CA 93514-3415 |
Second Address | Bishop, CA 93514-3415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2009 |
Last Update Date | 04/02/2021 |