Provider Demographics
NPI:1265825905
Name:HENDERSON, KELSEY (DPT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
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 1:8720 NORTHPARK BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9220
Mailing Address - Country:US
Mailing Address - Phone:843-225-6985
Mailing Address - Fax:843-225-6986
Practice Address - Street 1:8720 NORTHPARK BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9220
Practice Address - Country:US
Practice Address - Phone:843-225-6985
Practice Address - Fax:843-225-6986
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist