Provider Demographics
NPI:1083625289
Name:HENDERSON, KRISTY DANIELLE (ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DANIELLE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SOMERSET PL
Mailing Address - Street 2:APT 15
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3743
Mailing Address - Country:US
Mailing Address - Phone:502-384-3705
Mailing Address - Fax:
Practice Address - Street 1:3-G25 GENERAL ELECTRIC WORK-FIT CTR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40225-0001
Practice Address - Country:US
Practice Address - Phone:502-452-3605
Practice Address - Fax:502-452-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer