Provider Demographics
NPI:1285640151
Name:HENRY, JAY THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:HENRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SUNSET RIDGE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1036
Mailing Address - Country:US
Mailing Address - Phone:845-256-0820
Mailing Address - Fax:845-256-9028
Practice Address - Street 1:40 SUNSET RIDGE RD
Practice Address - Street 2:STE 250
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1036
Practice Address - Country:US
Practice Address - Phone:845-256-0820
Practice Address - Fax:845-256-9028
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ36A71Medicare PIN