Provider Demographics
NPI:1184921504
Name:HENDERSON, HORACE TYRONE (MBA, M ED)
Entity type:Individual
Prefix:
First Name:HORACE
Middle Name:TYRONE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MBA, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 W LAKE MEAD BLVD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0265
Mailing Address - Country:US
Mailing Address - Phone:702-562-7253
Mailing Address - Fax:702-562-8162
Practice Address - Street 1:7473 W LAKE MEAD BLVD
Practice Address - Street 2:SUITE #204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0265
Practice Address - Country:US
Practice Address - Phone:702-562-7253
Practice Address - Fax:702-562-8162
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner