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General NPI Number Information
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NPI Number | 1891103768
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Entity Type | Individual
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Provider Name | JULIETTE HENDERSON MS, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038 ATTN: MCEU-BAV-CRE
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City | APO
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State | AE
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Zip | 09112
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Country | US
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Telephone | 954-336-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 1527 ALBENGA AVE UV 1-403D
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City | CORAL GABLES
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State | FL
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Zip | 33146-4000
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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