Provider Demographics
NPI:1245563428
Name:HENDERSON, AMBER NOEL (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NOEL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12371 NE 51ST TER
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-9610
Mailing Address - Country:US
Mailing Address - Phone:865-809-2483
Mailing Address - Fax:
Practice Address - Street 1:12371 NE 51ST TER
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-9610
Practice Address - Country:US
Practice Address - Phone:865-809-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-06
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-005482225100000X
FL26158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist