Provider Demographics
NPI:1275939787
Name:HENRY, PAULA (LMP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 NE 71ST ST
Mailing Address - Street 2:UNIT 70
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-4719
Mailing Address - Country:US
Mailing Address - Phone:360-936-6706
Mailing Address - Fax:360-687-8458
Practice Address - Street 1:11515 NE 71ST ST
Practice Address - Street 2:UNIT 70
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-4719
Practice Address - Country:US
Practice Address - Phone:360-936-6706
Practice Address - Fax:360-687-8458
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60323408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist