Individual
MR. MICHAEL HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1005 N HICKORY RD, SOUTH BEND, IN 46615-3723
(574) 233-5754
(574) 233-7406
Mailing address
14463 THELMA CT, GRANGER, IN 46530-8460
(574) 271-1065
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05008295A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000356942
ANTHEM
IN
Enumeration date
09/29/2006
Last updated
07/08/2007
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