Provider Demographics
NPI:1083837082
Name:HENRY, IAN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24495 SW 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33031-4004
Mailing Address - Country:US
Mailing Address - Phone:305-302-4444
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 SW 161ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3826
Practice Address - Country:US
Practice Address - Phone:786-208-2814
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 18890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist