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NPI Code Detail

MEDICARE: ERICKA HENDERSON

MEDICARE:   ERICKA  HENDERSON
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
1225200000XPhysical Therapy Assistant160008202IL

General Provider Information

NPI Number : 1679220347
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICKA HENDERSON
Provider Business Mailing Address
First Line : 405 WASHINGTON BLVD
Second Line :
City : OAK PARK
State : IL
Zip : 60302-4036
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1111 ONTARIO ST
Second Line :
City : OAK PARK
State : IL
Zip : 60302-1939
Country : US
Telephone Number : 708-934-7149
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2022
Last Update Date : 03/03/2022

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Directions to “ ERICKA HENDERSON ” Practice Location

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