Provider Demographics
NPI:1033357850
Name:HENDERSON, ALBERTINE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ALBERTINE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 NORTH DEER ISLE RD.
Mailing Address - Street 2:
Mailing Address - City:DEE ISLE,
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-478-5630
Mailing Address - Fax:
Practice Address - Street 1:587 NORTH DEER ISLE RD.
Practice Address - Street 2:
Practice Address - City:DEE ISLE,
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-478-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME225200000X225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME225200000OtherPHYSICAL THERAPY ASSISTANT