Individual
KAYLIN S HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 CALLE EL CENTRO, FORT BAYARD, NM 88036
(505) 537-8782
(505) 537-2167
Mailing address
PO BOX 36219, 100 CALLE EL CENTRO, FORT BAYARD, NM 88036
(505) 537-8782
(505) 537-2167
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2112
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62974068
—
NM
Enumeration date
06/29/2007
Last updated
07/08/2007
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