Individual
AUSTIN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 S 6TH ST, PONCHATOULA, LA 70454-3317
(985) 386-6884
Mailing address
132 S 6TH ST, PONCHATOULA, LA 70454-3317
(985) 386-6884
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11216
LA
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
02/04/2019
Last updated
05/23/2022
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