Provider Demographics
NPI:1427502673
Name:HENRY, CHERYL LYNNE (PTA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNNE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9796 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5628
Mailing Address - Country:US
Mailing Address - Phone:814-592-6230
Mailing Address - Fax:
Practice Address - Street 1:9796 PORTOFINO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5628
Practice Address - Country:US
Practice Address - Phone:814-592-6230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26723225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant