Provider Demographics
NPI:1477815405
Name:HENDERSON, RACHEL LYNNE THIEL (DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNNE THIEL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNNE
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:103 FRIENDFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-9048
Mailing Address - Country:US
Mailing Address - Phone:414-552-0820
Mailing Address - Fax:704-889-0159
Practice Address - Street 1:103 DOVER ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8595
Practice Address - Country:US
Practice Address - Phone:704-889-0160
Practice Address - Fax:704-889-0159
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12041-24225100000X
NCP17793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist