Provider Demographics
NPI:1891103768
Name:HENDERSON, JULIETTE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:JULIETTE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1527 ALBENGA AVE
Mailing Address - Street 2:UV 1-403D
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-4000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US ARMY MEDICAL ACTIVITY-BAVARIA UNIT 28038
Practice Address - Street 2:ATTN: MCEU-BAV-CRE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:954-336-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer