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NPI Code Detail

MEDICARE: MR. MICHAEL HENDERSON P.T.

MEDICARE: MR. MICHAEL HENDERSON P.T.
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 Therapist05008295AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000356942OTHERINANTHEM

General Provider Information

NPI Number : 1659463354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL HENDERSON P.T.
Provider Business Mailing Address
First Line : 14463 THELMA CT
Second Line :
City : GRANGER
State : IN
Zip : 46530-8460
Country : US
Telephone Number : 574-271-1065
Fax Number :
Provider Business Practice Location Address
First Line : 1005 N HICKORY RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46615-3723
Country : US
Telephone Number : 574-233-5754
Fax Number : 574-233-7406
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 07/08/2007

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Directions to “ MR. MICHAEL HENDERSON P.T.” Practice Location

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