Provider Demographics
NPI:1548525439
Name:HENDERSON, ASHLEY MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:MCLELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:107 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5155
Mailing Address - Country:US
Mailing Address - Phone:870-818-0103
Mailing Address - Fax:
Practice Address - Street 1:107 SUNSET LN
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5155
Practice Address - Country:US
Practice Address - Phone:870-818-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2193225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant