Provider Demographics
NPI:1942447180
Name:HENRY, BENJAMIN PATRICK (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:HENRY
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20520 BOTHELL EVERETT HWY
Mailing Address - Street 2:A201
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7280
Mailing Address - Country:US
Mailing Address - Phone:309-830-1644
Mailing Address - Fax:
Practice Address - Street 1:20520 BOTHELL EVERETT HWY
Practice Address - Street 2:A201
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7280
Practice Address - Country:US
Practice Address - Phone:309-830-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer