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NPI Code Detail

MEDICARE: MRS. KRISTIN K HENDERSON MPT

MEDICARE: MRS. KRISTIN K HENDERSON MPT
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 Therapist5501009008MI

General Provider Information

NPI Number : 1508358763
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN K HENDERSON MPT
Provider Business Mailing Address
First Line : 585 E FLINT ST
Second Line :
City : LAKE ORION
State : MI
Zip : 48362-3209
Country : US
Telephone Number : 248-693-0505
Fax Number :
Provider Business Practice Location Address
First Line : 585 E FLINT ST
Second Line :
City : LAKE ORION
State : MI
Zip : 48362-3209
Country : US
Telephone Number : 248-693-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2018
Last Update Date : 06/04/2018

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