Healthcare Provider Details

I. General information

NPI: 1932525847
Provider Name (Legal Business Name): LOURDES HENRY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2014
Last Update Date: 03/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6749 LAS COLINAS ST
LAKE WORTH FL
33463-6566
US

IV. Provider business mailing address

9115 CAVATINA PL
BOYNTON BEACH FL
33472-5132
US

V. Phone/Fax

Practice location:
  • Phone: 561-667-0911
  • Fax:
Mailing address:
  • Phone: 561-715-1371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: