Provider Demographics
NPI:1942393707
Name:HENDERSON, ARLENE WYNETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:WYNETTE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ARLENE
Other - Middle Name:WYNETTE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:185 EASTGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-2868
Mailing Address - Country:US
Mailing Address - Phone:254-412-2667
Mailing Address - Fax:254-799-7568
Practice Address - Street 1:185 EASTGATE PLZ
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-2868
Practice Address - Country:US
Practice Address - Phone:254-412-2667
Practice Address - Fax:254-799-5768
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist