Provider Demographics
NPI:1427451244
Name:HENRY, MICHAEL JR (PT, DPT, PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HENRY
Suffix:JR
Gender:M
Credentials:PT, DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 FLAT SHOALS PKWY BUILDING C SUITE 300 A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4106
Mailing Address - Country:US
Mailing Address - Phone:404-793-2025
Mailing Address - Fax:404-793-2020
Practice Address - Street 1:4153 FLAT SHOALS PKWY BUILDING C
Practice Address - Street 2:SUITE 300 A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-793-2025
Practice Address - Fax:404-793-2020
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007592261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy