Provider Demographics
NPI:1295762474
Name:HENKE, GRETA A (PT)
Entity type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:A
Last Name:HENKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:SCHULENBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78956-1532
Mailing Address - Country:US
Mailing Address - Phone:979-743-2108
Mailing Address - Fax:979-743-2109
Practice Address - Street 1:411 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956-1532
Practice Address - Country:US
Practice Address - Phone:979-743-2108
Practice Address - Fax:979-743-2109
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X
TX1156521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282040905Medicaid
TX282040904Medicaid