Basic Information
| Provider Information | |||||||||
| NPI: | 1346639358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | T'KEYAH | ||||||||
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| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1817 SHERWOOD ST APT B | ||||||||
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| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27403 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
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| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362753325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2015 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | LAT-2544 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.