Provider Demographics
NPI:1699962001
Name:HENDERSON, JAMES GABRIEL III (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GABRIEL
Last Name:HENDERSON
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 RIVER CROSS RD
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4613
Mailing Address - Country:US
Mailing Address - Phone:801-798-7660
Mailing Address - Fax:801-804-6748
Practice Address - Street 1:462 RIVER CROSS RD
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-4613
Practice Address - Country:US
Practice Address - Phone:801-798-7660
Practice Address - Fax:801-804-6748
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344326-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist