Provider Demographics
NPI:1295035012
Name:HENRY, ERIC J (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
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 1:15877 SURFBIRD CT
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9116
Mailing Address - Country:US
Mailing Address - Phone:501-470-5320
Mailing Address - Fax:
Practice Address - Street 1:15877 SURFBIRD CT
Practice Address - Street 2:
Practice Address - City:MASCOTTE
Practice Address - State:FL
Practice Address - Zip Code:34753-9116
Practice Address - Country:US
Practice Address - Phone:501-470-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist