Provider Demographics
NPI:1679842991
Name:HENDERSON, KATHLYN HILL (PT, CWS)
Entity Type:Individual
Prefix:MRS
First Name:KATHLYN
Middle Name:HILL
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PT, CWS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1430 W. BADDOUR PARKWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-453-1422
Mailing Address - Fax:615-453-1429
Practice Address - Street 1:1430 W. BADDOUR PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-453-1422
Practice Address - Fax:615-453-1429
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370237Medicare UPIN