MEDICARE: LOURDES HENRY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	6276	FL

General Provider Information

NPI Number	:	1932525847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES HENRY PT

Provider Business Mailing Address
First Line	:	9115 CAVATINA PL
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-5132
Country	:	US
Telephone Number	:	561-715-1371
Fax Number	:

Provider Business Practice Location Address
First Line	:	6749 LAS COLINAS ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6566
Country	:	US
Telephone Number	:	561-667-0911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2014
Last Update Date	:	03/16/2014

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