Healthcare Provider Details

I. General information

NPI: 1184537656
Provider Name (Legal Business Name): SAMUEL HENDERSON LMBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 FAHEY DR
APEX NC
27502-7093
US

IV. Provider business mailing address

1953 FAHEY DR
APEX NC
27502-7093
US

V. Phone/Fax

Practice location:
  • Phone: 919-823-7215
  • Fax:
Mailing address:
  • Phone: 214-679-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23437
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: