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General NPI Number Information
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NPI Number | 1134804560
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Entity Type | Individual
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Provider Name | ERIC HENRY
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Gender | Male
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 500 MERIDIAN HILLS DR
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City | LOUISVILLE
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State | KY
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Zip | 40243-2234
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Country | US
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Telephone | 502-245-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 61 STONE CREST DR
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City | FISHERVILLE
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State | KY
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Zip | 40023-7402
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Country | US
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Telephone | 502-235-7137
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A02399
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License Number State | KY
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