Provider Demographics
NPI:1174717763
Name:RICHARD A. HENRY, PA
Entity type:Organization
Organization Name:RICHARD A. HENRY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALVA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-578-4443
Mailing Address - Street 1:4492 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4513
Mailing Address - Country:US
Mailing Address - Phone:954-578-4443
Mailing Address - Fax:954-578-4868
Practice Address - Street 1:4492 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4513
Practice Address - Country:US
Practice Address - Phone:954-578-4443
Practice Address - Fax:954-578-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8692111N00000X
111N00000X, 133NN1002X, 171100000X, 225100000X, 225700000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89496OtherBCBS FL
FL381791100Medicaid
FL381791100Medicaid