Provider Demographics
NPI:1619273315
Name:HENDERSON, CHRISTINA (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HENDERSON
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 1:8514 W GAGE BLVD STE F29
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8108
Mailing Address - Country:US
Mailing Address - Phone:704-451-6069
Mailing Address - Fax:
Practice Address - Street 1:8514 W GAGE BLVD STE F29
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8108
Practice Address - Country:US
Practice Address - Phone:704-451-6069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60205710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0274679OtherL & I