Active NPI
Jean Elaine Henriksen, P.T.
- Pediatric Physical Therapist
- Marana, AZ
National Provider Identifier
1710031729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1145
- Practice address
- 11279 W Grier Rd
Marana, AZ 85653-9609 - Phone
- (520) 682-4782
- Fax
- (520) 682-4818
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1145 | AZ | Primary |
Addresses
Primary practice location
11279 W Grier Rd
Marana, AZ 85653-9609
Mailing address
6315 N Desert Willow Dr
Tucson, AZ 85743-8702
Phone (520) 744-4769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1145 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710031729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6315 N DESERT WILLOW DR",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857438702",
"telephone_number": "520-744-4769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11279 W GRIER RD",
"city": "MARANA",
"state": "AZ",
"postal_code": "856539609",
"telephone_number": "520-682-4782",
"fax_number": "520-682-4818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRIKSEN",
"first_name": "JEAN",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "AZ",
"license": "1145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marana, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.