Provider Demographics
NPI:1457316549
Name:HENDERSON, VIRGINIA K (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:K
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SPEIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1507
Mailing Address - Country:US
Mailing Address - Phone:254-710-1010
Mailing Address - Fax:254-710-2499
Practice Address - Street 1:209 SPEIGHT AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1507
Practice Address - Country:US
Practice Address - Phone:254-710-1010
Practice Address - Fax:254-710-2499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist