Provider Demographics
NPI:1659327385
Name:HENKE, GREGORY PAUL (LMT CNMT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PAUL
Last Name:HENKE
Suffix:
Gender:M
Credentials:LMT CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35759 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:OR
Mailing Address - Zip Code:97374-9771
Mailing Address - Country:US
Mailing Address - Phone:503-394-4777
Mailing Address - Fax:503-394-1059
Practice Address - Street 1:35759 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:SCIO
Practice Address - State:OR
Practice Address - Zip Code:97374-9771
Practice Address - Country:US
Practice Address - Phone:503-394-4777
Practice Address - Fax:503-394-1059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation