MEDICARE: JUDY HENRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT013373	GA

General Provider Information

NPI Number	:	1598479164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY HENRY

Provider Business Mailing Address
First Line	:	3830 TENNESSEE AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2663
Country	:	US
Telephone Number	:	813-576-6082
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 TENNESSEE AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2663
Country	:	US
Telephone Number	:	770-212-1719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	02/23/2025

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