Individual
KENNETH J HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
245 NE 30 RD, GREAT BEND, KS 67530-9251
(620) 792-9371
(620) 786-1161
Mailing address
245 NE 30 RD, GREAT BEND, KS 67530-9251
(620) 792-9371
(620) 786-1161
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-00048
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PROVIDER CODE 22
REHAB. & RESTORATIVE SERV
KS
Enumeration date
06/28/2006
Last updated
07/08/2007
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