Provider Demographics
NPI:1790919538
Name:HERINCKX, ALLEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:HERINCKX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 SKYLINE RD S STE 90
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2879
Mailing Address - Country:US
Mailing Address - Phone:503-566-7700
Mailing Address - Fax:
Practice Address - Street 1:4999 SKYLINE RD S STE 90
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-2879
Practice Address - Country:US
Practice Address - Phone:503-566-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2018-04-30
Deactivation Date:2018-03-28
Deactivation Code:
Reactivation Date:2018-04-25
Provider Licenses
StateLicense IDTaxonomies
OR61448225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty