Provider Demographics
NPI:1932985827
Name:HENDERSON, JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 RIVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-5622
Mailing Address - Country:US
Mailing Address - Phone:614-557-1033
Mailing Address - Fax:
Practice Address - Street 1:65 OLD COLONY WAY
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3213
Practice Address - Country:US
Practice Address - Phone:508-240-7203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist