Provider Demographics
NPI:1154484863
Name:HENRY, MARGARET MARIE (LMP, LPTA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARIE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMP, LPTA
Other - Prefix:
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP, LPTA
Mailing Address - Street 1:PO BOX 4103
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-0103
Mailing Address - Country:US
Mailing Address - Phone:360-352-5993
Mailing Address - Fax:360-352-8213
Practice Address - Street 1:3912 MARTIN WAY E.
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-459-9780
Practice Address - Fax:360-412-0581
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7514225200000X
WAMA0000373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist