Provider Demographics
NPI:1578635298
Name:HENDERSHOT, CAROL MILLER (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MILLER
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2526
Mailing Address - Country:US
Mailing Address - Phone:509-326-1651
Mailing Address - Fax:509-326-1658
Practice Address - Street 1:2118 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2526
Practice Address - Country:US
Practice Address - Phone:509-326-1651
Practice Address - Fax:509-326-1658
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010147789OtherREGENCE BLUE SHIELD
WA8953HEOtherASURIS NW HEALTH