Provider Demographics
NPI:1710041199
Name:HENRY, L GEORGE (LMT)
Entity Type:Individual
Prefix:MR
First Name:L
Middle Name:GEORGE
Last Name:HENRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 ROBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2633
Mailing Address - Country:US
Mailing Address - Phone:863-991-5401
Mailing Address - Fax:863-381-8617
Practice Address - Street 1:1723 ROBERTA AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2633
Practice Address - Country:US
Practice Address - Phone:863-991-5401
Practice Address - Fax:863-381-8617
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 31019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist