Provider Demographics
NPI:1790991750
Name:HENDERSON, VALERIE JEAN (PT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7545
Mailing Address - Country:US
Mailing Address - Phone:360-966-2201
Mailing Address - Fax:
Practice Address - Street 1:3121 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1937
Practice Address - Country:US
Practice Address - Phone:360-734-6760
Practice Address - Fax:360-752-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217305OtherLABOR AND INDUSTRIES