Individual
MICHELLE HENAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2146
(901) 747-1800
(901) 747-1801
Mailing address
100 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2146
(901) 747-1800
(901) 747-1801
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11568
CT
225100000X
Physical Therapist
Primary
12045
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190328
—
CT
Enumeration date
08/17/2017
Last updated
04/14/2020
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