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General NPI Number Information
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NPI Number | 1992339527
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Entity Type | Individual
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Provider Name | ALISHA M HENDERSON
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 5100 KELL BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1746
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Country | US
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Telephone | 940-691-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 4344 CUNNINGHAM DR
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2611
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Country | US
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Telephone | 302-745-0023
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1159899
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License Number State | TX
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