Provider Demographics
NPI:1659771137
Name:HENDERSON, VICTORIA LORRAINE (ATC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LORRAINE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 HALCYON DOWNS LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7756
Mailing Address - Country:US
Mailing Address - Phone:334-318-0624
Mailing Address - Fax:
Practice Address - Street 1:1615 WINDSOR HILL CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-0168
Practice Address - Country:US
Practice Address - Phone:334-239-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program