Provider Demographics
NPI:1881630556
Name:HENDERSON, JASON (DPT)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 FRANKLIN ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2547
Mailing Address - Country:US
Mailing Address - Phone:240-417-2502
Mailing Address - Fax:202-318-8174
Practice Address - Street 1:6196 OXON HILL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3100
Practice Address - Country:US
Practice Address - Phone:301-567-6400
Practice Address - Fax:202-318-8174
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT2651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02503E02Medicare PIN