Provider Demographics
NPI:1518981422
Name:HENDERSON, MAUREEN HOLLY (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:HOLLY
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 1:7235 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2148
Mailing Address - Country:US
Mailing Address - Phone:529-841-2345
Mailing Address - Fax:952-841-2346
Practice Address - Street 1:7235 OHMS LN
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2148
Practice Address - Country:US
Practice Address - Phone:529-841-2345
Practice Address - Fax:952-841-2346
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP44369OtherHEALTHPARTNERS
MN24373OtherAMERICA'S PPO
MN03A91HEOtherBCBS OF MN
MN962871010735OtherPREFERRED ONE
MN6402798OtherMEDICA