Healthcare Provider Details

I. General information

NPI: 1083558290
Provider Name (Legal Business Name): CHRISTOPHER LEE HENRY SR. CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CARACARA CT
HUBER HEIGHTS OH
45424-4502
US

IV. Provider business mailing address

4900 CARACARA CT
HUBER HEIGHTS OH
45424-4502
US

V. Phone/Fax

Practice location:
  • Phone: 937-624-3212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007643
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: