Cornelius Henderson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1301027 Issued in TX

Practice address

711 Avignon Dr
Ridgeland, MS 39157-5120

Phone

(601) 605-6777

Fax

(601) 605-8869

NPI assigned

Nov 6, 2007

Last updated

Mar 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Luna Care Physical Therapy LLCGroup PAC ID 0648692723, 271 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Texas Luna Care Physical Therapy LLC

  • Physical Therapist
  • Southlake, TX
  • NPI 1790309656
  Medicare reassignment Care Compare group NPD
• Baylor College of Medicine

  dba BCM Physicians

  • Ph.D. Medical Genetics
  • Houston, TX
  • NPI 1881026664
  Medicare reassignment NPD
• Baylor College of Medicine

  • Orthopaedic Surgery Physician
  • Sugar Land, TX
  • NPI 1700683844
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1245410323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1944 KATY FORT BEND RD APT 5106",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774934797",
            "telephone_number": "281-900-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 AVIGNON DR",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391575120",
            "telephone_number": "601-605-6777",
            "fax_number": "601-605-8869"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1944 Katy Fort Bend Rd Apt 5106",
            "address_purpose": "LOCATION",
            "city": "Katy",
            "state": "TX",
            "postal_code": "774934797",
            "country_code": "US",
            "telephone_number": "281-900-9430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "CORNELIUS",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-11-06",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1301027",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA3890",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "chenderson@spotonwar.com",
            "affiliation": "N",
            "address_1": "2600 Westhollow Dr Apt 2113",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770821940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Connie Renee Hefner, LPTA
• Brittany Kerr Heinsz, SLP
• Heitzmann Dentistry (Magnolia family dental care)
• Casey Brian Heitzmann, DMD
• Emily Ann Heitzmann, D.M.D.
• James Keeton Henderson, LPC
• Ryleigh Henning
• Branden Henry, PHD.M.A., LPC, LMFTA
• Mark Angelo Henry Sr., LPTA
• John L Henson, DMD

• Physical Therapist in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.