Individual
MATTHEW HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4450 HUGH HOWELL RD STE 9, TUCKER, GA 30084-4917
(770) 939-0998
Mailing address
121 SPRINGDALE ST APT 17, DECATUR, GA 30030-2044
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8771
LICENSE#
GA
Enumeration date
04/13/2007
Last updated
07/08/2007
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