Provider Demographics
NPI:1124375597
Name:HENDERSON, TONYA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4203
Mailing Address - Country:US
Mailing Address - Phone:940-902-3979
Mailing Address - Fax:
Practice Address - Street 1:1019 E CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4203
Practice Address - Country:US
Practice Address - Phone:940-902-3979
Practice Address - Fax:214-292-9650
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-05
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT113298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist