Provider Demographics
NPI:1639388259
Name:HENRY, ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:6752 PARKER FARM DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3175
Mailing Address - Country:US
Mailing Address - Phone:910-679-4095
Mailing Address - Fax:910-338-1760
Practice Address - Street 1:6752 PARKER FARM DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-679-4095
Practice Address - Fax:910-338-1760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP125972251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports