Provider Demographics
NPI:1588980858
Name:HENRY, SHARON LEIGH (LMT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEIGH
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 S ALEX RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-5406
Mailing Address - Country:US
Mailing Address - Phone:937-299-3390
Mailing Address - Fax:
Practice Address - Street 1:1615 S. ALEX ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5406
Practice Address - Country:US
Practice Address - Phone:937-299-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-018743225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist