Provider Demographics
NPI:1124371976
Name:HENRY, RACHAEL JOY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:JOY
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MARCH AVE # B
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3363
Mailing Address - Country:US
Mailing Address - Phone:707-433-5219
Mailing Address - Fax:
Practice Address - Street 1:441 MARCH AVE # B
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3363
Practice Address - Country:US
Practice Address - Phone:707-433-5219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist