Individual
MS. HEATHER J HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1626 WELLS AVE, SUITE 105, MERIDIAN, ID 83642-4524
(208) 789-0200
(208) 288-2784
Mailing address
1626 WELLS AVE, SUITE 105, MERIDIAN, ID 83642-4524
(208) 789-0200
(208) 288-2784
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2550
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396070538
NPI
ID
Enumeration date
10/06/2009
Last updated
02/18/2015
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