Active NPI
Scott J Henderson, PT
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1720178940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501300688
- Practice address
- 4069 Lake Dr SE
Ste 114
Grand Rapids, MI 49546-8816 - Phone
- (616) 726-8365
- NPI assigned
- Oct 16, 2006
- Last updated
- Jul 8, 2007
- 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 | 5501300688 | MI | Primary |
Addresses
Primary practice location
4069 Lake Dr SE
Ste 114
Grand Rapids, MI 49546-8816
Mailing address
4085 Burton St SE
Ste 200
Grand Rapids, MI 49546-2444
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 |
|---|---|---|---|
| 5501300688 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720178940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4085 BURTON ST SE",
"address_2": "STE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4069 LAKE DR SE",
"address_2": "STE 114",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468816",
"telephone_number": "616-726-8365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "SCOTT",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501300688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.