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General NPI Number Information
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NPI Number | 1225121031
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Entity Type | Individual
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Provider Name | JESSICA ANN HENDERSON PT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 3450 COBB PKWY NW STE 220
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City | ACWORTH
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State | GA
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Zip | 30101-8352
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Country | US
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Telephone | 770-974-1978
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Fax |
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Provider Business Mailing Address
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Address Line | 6397 LEE HWY STE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4915
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 10130
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5722
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012429
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License Number State | GA
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