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NPI Code Detail

MEDICARE: SADIE MARIE HENDERSON DPT

MEDICARE:   SADIE MARIE HENDERSON  DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist43094CA

General Provider Information

NPI Number : 1669841243
Entity Type Code : Individual
Provider Name (Legal Business Name) : SADIE MARIE HENDERSON DPT
Provider Business Mailing Address
First Line : 1922 WEBSTER ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-2910
Country : US
Telephone Number : 510-271-4793
Fax Number :
Provider Business Practice Location Address
First Line : 1922 WEBSTER ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-2910
Country : US
Telephone Number : 510-271-4793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2015
Last Update Date : 09/24/2015

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Directions to “ SADIE MARIE HENDERSON DPT” Practice Location

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