Provider Demographics
NPI:1578694634
Name:HENRIKSEN, DELLA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:LYNN
Last Name:HENRIKSEN
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 1:117 S 51ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3523
Mailing Address - Country:US
Mailing Address - Phone:402-933-7840
Mailing Address - Fax:
Practice Address - Street 1:4809 REDMAN AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1842
Practice Address - Country:US
Practice Address - Phone:402-455-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist