Individual
MS. JACQUELYN MARIE HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
5361 BROWNWOOD DRIVE, POWDER SPRINGS, GA 30127-4719
(404) 849-2710
Mailing address
5361 BROWNWOOD DRIVE, POWDER SPRINGS, GA 30127-4719
(404) 849-2710
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005494
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199540486A
—
GA
Enumeration date
05/06/2010
Last updated
05/06/2010
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