Healthcare Provider Details

I. General information

NPI: 1285640151
Provider Name (Legal Business Name): JAY THOMAS HENRY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SUNSET RIDGE RD STE 250
NEW PALTZ NY
12561-1036
US

IV. Provider business mailing address

40 SUNSET RIDGE RD STE 250
NEW PALTZ NY
12561-1036
US

V. Phone/Fax

Practice location:
  • Phone: 845-256-0820
  • Fax: 845-256-9028
Mailing address:
  • Phone: 845-256-0820
  • Fax: 845-256-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: