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NPI Code Detail

MEDICARE: KASEY HENDERSON DPT

MEDICARE: KASEY HENDERSON DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305206546VA

General Provider Information

NPI Number : 1053626325
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY HENDERSON DPT
Provider Business Mailing Address
First Line : 108 WALTON PARK LN
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3028
Country : US
Telephone Number : 804-560-9575
Fax Number : 804-560-9557
Provider Business Practice Location Address
First Line : 108 WALTON PARK LN
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3028
Country : US
Telephone Number : 804-560-9575
Fax Number : 804-560-9557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2010
Last Update Date : 08/11/2010

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