Individual
MRS. RYAN WILLIAMS HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
103 MEDICAL PARK, HATTIESBURG, MS 39401-9042
(601) 268-5757
(601) 579-5220
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5757
(601) 579-5220
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3636
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08188360
—
MS
01
—
9244128
AETNA
MS
Enumeration date
02/07/2008
Last updated
07/17/2020
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