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General NPI Number Information
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NPI Number | 1083625289
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Entity Type | Individual
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Provider Name | KRISTY DANIELLE HENDERSON ATC/L
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3-G25 GENERAL ELECTRIC WORK-FIT CTR
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City | LOUISVILLE
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State | KY
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Zip | 40225-0001
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Country | US
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Telephone | 502-452-3605
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Fax | 502-452-0484
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Provider Business Mailing Address
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Address Line | 1708 SOMERSET PL APT 15
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City | LOUISVILLE
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State | KY
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Zip | 40220-3743
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Country | US
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Telephone | 502-384-3705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | OH
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