Individual
JACOB HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2106 EXECUTIVE DR, HAMPTON, VA 23666-2402
(757) 838-6678
(757) 838-8116
Mailing address
7121 NEWPORT AVE, NORFOLK, VA 23505-3924
(567) 249-8709
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2305212743
VA
Other
Enumeration date
05/17/2019
Last updated
06/20/2019
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