Active NPI
Joel M Henderson, DPT
- Physical Therapist
- Cannon Afb, NM
National Provider Identifier
1215430285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070023661
- Practice address
- 224 W D L Ingram Avenue
BLDG 1408
Cannon Afb, NM 88103 - Phone
- (575) 784-2778
- NPI assigned
- Mar 15, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070023661 | IL | Primary |
Addresses
Primary practice location
224 W D L Ingram Avenue
BLDG 1408
Cannon Afb, NM 88103
Mailing address
224 W DL Ingram Ave
BLDG 1408
Cannon Afb, NM 88103
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070023661 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1215430285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 W DL INGRAM AVE",
"address_2": "BLDG 1408",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 W D L INGRAM AVENUE",
"address_2": "BLDG 1408",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88103",
"telephone_number": "575-784-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "JOEL",
"middle_name": "M",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-15",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070023661",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Afb, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.