Provider Demographics
NPI:1295840502
Name:HENRY, PAUL A (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0430
Mailing Address - Country:US
Mailing Address - Phone:870-424-2224
Mailing Address - Fax:870-424-0493
Practice Address - Street 1:715 W 6TH ST
Practice Address - Street 2:OZARK PHYSICAL THERAPY SPECIALISTS
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3421
Practice Address - Country:US
Practice Address - Phone:870-424-2224
Practice Address - Fax:870-424-0493
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1565225100000X
MO103915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X108OtherBCBS
AR350406ZGR9Medicare PIN
AR5X108Medicare ID - Type Unspecified