Provider Demographics
NPI:1154942043
Name:HENDERSON, ALYSIA FRANCES (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:FRANCES
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 BALTIMORE AVENUE
Mailing Address - Street 2:RITCHIE COLISEUM 0100
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:301-226-4440
Mailing Address - Fax:
Practice Address - Street 1:7675 BALTIMORE AVENUE
Practice Address - Street 2:RITCHIE COLISEUM 0100
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:21144
Practice Address - Country:US
Practice Address - Phone:301-226-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00006172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer