Provider Demographics
NPI:1285189670
Name:HENDERSHOT, AFTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AFTON
Middle Name:
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6271 TALIAFERRO WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3707
Mailing Address - Country:US
Mailing Address - Phone:734-755-9703
Mailing Address - Fax:
Practice Address - Street 1:8348 TRAFORD LN
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1663
Practice Address - Country:US
Practice Address - Phone:703-569-7335
Practice Address - Fax:703-569-0665
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist