Provider Demographics
NPI:1336102631
Name:HENDERSON, KRISTEN LEIGH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:LEIGH
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2404
Mailing Address - Country:US
Mailing Address - Phone:850-875-0333
Mailing Address - Fax:850-875-0335
Practice Address - Street 1:108 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2404
Practice Address - Country:US
Practice Address - Phone:850-875-0333
Practice Address - Fax:085-875-0335
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19458225200000X
FLPT33163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT33163OtherPHYSICAL THERAPY