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General NPI Number Information
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NPI Number | 1437347150
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Entity Type | Organization
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Legal Business Name | HENDERSON PODIATRY, LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 882 MILLERSVILLE RD
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City | LANCASTER
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State | PA
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Zip | 17603
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Country | US
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Telephone | 717-291-0391
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Fax | 717-291-0832
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Provider Business Mailing Address
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Address Line | 882 MILLERSVILLE RD
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City | LANCASTER
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State | PA
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Zip | 17603-6154
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Country | US
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Telephone | 717-291-0391
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Fax | 717-291-0832
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Authorized Official
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Title or Position | OWNER
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Name | MARILYN C HENDERSON
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Credential | DPM
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Telephone | 717-291-0391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC002642L
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License Number State | PA
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