Individual ProviderKerry HennekePhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4504 Lilac Ln, Suite 1, Victoria, TX 77901-2625(361) 572-0385PECOS EnrollmentBased on the most recent information from CMS, provider Kerry Henneke does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1265473508Provider TypeIndividualFull NameHenneke, KerryCredentialP.T.GenderMaleSole ProprietorNoEnumeration Date6/9/2006Last Updated5/3/2012Contact InformationPractice LocationPractice Address4504 Lilac Ln, Suite 1, Victoria, TX 77901-2625Phone(361) 572-0385Fax(361) 572-0382Mailing LocationMailing Address4504 Lilac Ln, Suite 1, Victoria, TX 77901-2625Phone(361) 572-0385Fax(361) 572-0382Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1103943TexasProvider IdentifiersIDDescriptionIssuerID282708104DescriptionMedicaidIssuerUnlistedTexasID282708103DescriptionMedicaidIssuerUnlistedTexas