Active NPI
Jason Henry
- Geriatric Physical Therapist
- Hannibal, MO
National Provider Identifier
1891088209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- PT60201832
- Practice address
- 164 Lake Apollo Dr
Hannibal, MO 63401-2308 - Phone
- (858) 200-5690
- NPI assigned
- May 17, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | PT60201832 | WA | Primary |
Addresses
Primary practice location
164 Lake Apollo Dr
Hannibal, MO 63401-2308
Mailing address
PO Box 1222
Hannibal, MO 63401-1222
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 |
|---|---|---|---|
| PT60201832 | WA | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305590400000",
"number": "1891088209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1222",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634011222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 LAKE APOLLO DR",
"city": "HANNIBAL",
"state": "MO",
"postal_code": "634012308",
"telephone_number": "858-200-5690"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRY",
"first_name": "JASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-17",
"last_updated": "2011-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "WA",
"license": "PT60201832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.