Healthcare Provider Details

I. General information

NPI: 1245563428
Provider Name (Legal Business Name): AMBER NOEL HENDERSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2009
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12371 NE 51ST TER
OXFORD FL
34484-9610
US

IV. Provider business mailing address

12371 NE 51ST TER
OXFORD FL
34484-9610
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-2483
  • Fax:
Mailing address:
  • Phone: 865-809-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-005482
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: