Healthcare Provider Details

I. General information

NPI: 1235161159
Provider Name (Legal Business Name): CHRISTOPHER HENDERSON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 S 76TH ST
GREENFIELD WI
53220-4361
US

IV. Provider business mailing address

8660 ROTE RD
ROCKFORD IL
61107-5412
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-8180
  • Fax:
Mailing address:
  • Phone: 815-289-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: