Provider Demographics
NPI:1083639280
Name:HENDERSON, GAIL THERESA (MS,ATC,PT,CCRP)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:THERESA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS,ATC,PT,CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHANDLER LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3855
Mailing Address - Country:US
Mailing Address - Phone:860-350-5579
Mailing Address - Fax:860-355-0495
Practice Address - Street 1:350 LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2003
Practice Address - Country:US
Practice Address - Phone:860-350-5579
Practice Address - Fax:860-355-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist