Active NPI
Caresse Henderson
- Physical Therapist
- Bel Air, MD
National Provider Identifier
1417798372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT210002615
- Practice address
- 12 Medstar Blvd
Bel Air, MD 21015-1798 - Phone
- (410) 877-8078
- NPI assigned
- Jun 4, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physical Therapist | 225100000X | PT210002615 | DC | Primary |
Addresses
Primary practice location
12 Medstar Blvd
Bel Air, MD 21015-1798
Mailing address
5200 W Le Moyne St
Chicago, IL 60651-1419
Phone (312) 316-0607
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT210002615 | DC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779926400000",
"number": "1417798372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 W LE MOYNE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606511419",
"telephone_number": "312-316-0607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 MEDSTAR BLVD",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210151798",
"telephone_number": "410-877-8078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "CARESSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-04",
"last_updated": "2026-05-28",
"certification_date": "2026-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "DC",
"license": "PT210002615",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bel Air, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.