Provider Demographics
NPI:1912265281
Name:HENRY, EARL S (CRT)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:S
Last Name:HENRY
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3438
Mailing Address - Country:US
Mailing Address - Phone:305-653-0965
Mailing Address - Fax:
Practice Address - Street 1:1340 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-3438
Practice Address - Country:US
Practice Address - Phone:305-653-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT1691227800000X
GATT1691227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty