Provider Demographics
NPI:1366438525
Name:HENRY, MITCHELL RAYMOND (PT)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:RAYMOND
Last Name:HENRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4154
Mailing Address - Country:US
Mailing Address - Phone:814-941-7708
Mailing Address - Fax:814-941-7715
Practice Address - Street 1:1165 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8251
Practice Address - Country:US
Practice Address - Phone:814-342-3930
Practice Address - Fax:814-342-3935
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007106L225100000X
PADAT 000020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA892862OtherHIGHMARK
P62920Medicare UPIN
PA059404PRYMedicare ID - Type Unspecified