Healthcare Provider Details

I. General information

NPI: 1891103768
Provider Name (Legal Business Name): JULIETTE HENDERSON MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIETTE KIM

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038 ATTN: MCEU-BAV-CRE
APO AE
09112
US

IV. Provider business mailing address

1527 ALBENGA AVE UV 1-403D
CORAL GABLES FL
33146-4000
US

V. Phone/Fax

Practice location:
  • Phone: 954-336-7176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: