Provider Demographics
NPI:1750118550
Name:HENDERSON, WENDY (LMT, NMT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2215
Mailing Address - Street 2:
Mailing Address - City:DOLORES
Mailing Address - State:CO
Mailing Address - Zip Code:81323-2215
Mailing Address - Country:US
Mailing Address - Phone:970-799-2263
Mailing Address - Fax:
Practice Address - Street 1:28 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3738
Practice Address - Country:US
Practice Address - Phone:970-799-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0007225225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist