Provider Demographics
NPI:1881010155
Name:HENRY, KRISTEN J (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
Last Name:HENRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:J
Other - Last Name:STUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1 GRENOBLE PL
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-2847
Mailing Address - Country:US
Mailing Address - Phone:302-644-0822
Mailing Address - Fax:302-644-1722
Practice Address - Street 1:1 GRENOBLE PL
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-2847
Practice Address - Country:US
Practice Address - Phone:302-644-0822
Practice Address - Fax:302-644-1722
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist