Provider Demographics
NPI:1194860171
Name:HENDERSON, JEFFREY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PINKERTON DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1213
Mailing Address - Country:US
Mailing Address - Phone:412-403-0711
Mailing Address - Fax:
Practice Address - Street 1:107 PINKERTON DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-1213
Practice Address - Country:US
Practice Address - Phone:412-403-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017634225100000X
CAPT32765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist