Doctor Name: | MRS. MELISSA JO HENRIKSON |
NPI Number: | 1104231919 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 227.003885 |
Business Practice Address: | 420 Crossing Dr Sherman, IL - 626849640 |
Business Phone Number: | 2174963636 |
Business Fax Number: | 2174963838 |
Mailing Address: | Po Box 380, SHERMAN |
State: | IL |
Postal Code: | 626840380 |
Phone Number: | 2174963636 |
Fax Number: | 2174963838 |
NPI Enumeration Date: | 07/01/2014 |
NPI Last Update Date: | 07/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 227.003885 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |