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General NPI Number Information
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NPI Number | 1699962001
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Entity Type | Individual
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Provider Name | JAMES GABRIEL HENDERSON III P.T.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 09/29/2007
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Provider Practice Location Address
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Address Line | 462 RIVER CROSS RD
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City | SPANISH FORK
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State | UT
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Zip | 84660-4613
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Country | US
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Telephone | 801-798-7660
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Fax | 801-804-6748
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Provider Business Mailing Address
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Address Line | 462 RIVER CROSS RD
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City | SPANISH FORK
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State | UT
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Zip | 84660-4613
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Country | US
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Telephone | 801-798-7660
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Fax | 801-804-6748
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 344326-2401
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License Number State | UT
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