MEDICARE: MRS. ADRIENNE ATWOOD 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
1	225100000X	Physical Therapist	8578	NC

General Provider Information

NPI Number	:	1770787889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIENNE ATWOOD HENDERSON MPT

Provider Business Mailing Address
First Line	:	2407 BERKLEY PL
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 NEW GARDEN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-3267
Country	:	US
Telephone Number	:	336-851-0612
Fax Number	:	336-851-0612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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