Provider Demographics
NPI:1477856532
Name:HENRY, SUE-BROWN
Entity Type:Individual
Prefix:
First Name:SUE-BROWN
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20728 DUPONT BLVD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-3199
Mailing Address - Country:US
Mailing Address - Phone:302-858-5111
Mailing Address - Fax:
Practice Address - Street 1:20728 DUPONT BLVD
Practice Address - Street 2:SUITE 317
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-3199
Practice Address - Country:US
Practice Address - Phone:302-858-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT-0002654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist