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General NPI Number Information
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NPI Number | 1710041199
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Entity Type | Individual
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Provider Name | L GEORGE HENRY LMT
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 1723 ROBERTA AVE
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City | SEBRING
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State | FL
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Zip | 33870-2633
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Country | US
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Telephone | 863-991-5401
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Fax | 863-381-8617
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Provider Business Mailing Address
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Address Line | 1723 ROBERTA AVE
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City | SEBRING
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State | FL
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Zip | 33870-2633
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Country | US
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Telephone | 863-991-5401
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Fax | 863-381-8617
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 31019
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License Number State | FL
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