Provider Demographics
NPI:1821242959
Name:HENRY, FAITH MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 WILKINS RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9568
Mailing Address - Country:US
Mailing Address - Phone:607-272-5891
Mailing Address - Fax:
Practice Address - Street 1:3226 WILKINS RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9568
Practice Address - Country:US
Practice Address - Phone:607-272-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005989-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant