Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01190600 | NJ |
NPI | 1003024142 |
---|---|
Provider Name | Allison Henderson |
First Address | Southampton, NJ 08088 |
Second Address | Voorhees, NJ 08043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |