Provider Demographics
NPI:1427114669
Name:BADER-MCHENRY, ANNE C (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:BADER-MCHENRY
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 1:2042 EGRET DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8325
Mailing Address - Country:US
Mailing Address - Phone:209-832-9605
Mailing Address - Fax:209-832-9605
Practice Address - Street 1:2042 EGRET DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8325
Practice Address - Country:US
Practice Address - Phone:209-832-9605
Practice Address - Fax:209-832-9605
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT256740Medicare PIN