Organization
LORETTA V HENDERSON, DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORETTA V HENDERSON DPM (PROPRIETOR)
(866) 365-3668
Entity
Organization
Contact information
Practice address
1543 ALDERSGATE DR, KISSIMMEE, FL 34746-6545
(866) 365-3668
(407) 281-4044
Mailing address
PO BOX 720849, ORLANDO, FL 32872-0849
(866) 365-3668
(407) 281-4044
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
P00001685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029627900
—
FL
Enumeration date
02/13/2008
Last updated
01/21/2012
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