Provider Demographics
NPI:1376145896
Name:HENDERSON, RICHARD PORTER (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PORTER
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NE 92ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2716
Mailing Address - Country:US
Mailing Address - Phone:214-733-2973
Mailing Address - Fax:
Practice Address - Street 1:9107 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3132
Practice Address - Country:US
Practice Address - Phone:206-316-8042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist