Provider Demographics
NPI:1770700296
Name:HENDERSON, ALISON DENISE (MPT)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:DENISE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KETTLEMAN LN S
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-2980
Mailing Address - Country:US
Mailing Address - Phone:512-636-5922
Mailing Address - Fax:
Practice Address - Street 1:301 KETTLEMAN LN S
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-2980
Practice Address - Country:US
Practice Address - Phone:512-636-5922
Practice Address - Fax:206-935-0357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000082012251X0800X
TX13067352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic