Provider Demographics
NPI:1184941080
Name:HENNABERRY, FAIE M (LMP, CCT)
Entity type:Individual
Prefix:MS
First Name:FAIE
Middle Name:M
Last Name:HENNABERRY
Suffix:
Gender:F
Credentials:LMP, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 93RD LN NE
Mailing Address - Street 2:#102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3682
Mailing Address - Country:US
Mailing Address - Phone:425-242-1662
Mailing Address - Fax:
Practice Address - Street 1:11815 93RD LN NE
Practice Address - Street 2:#102
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3682
Practice Address - Country:US
Practice Address - Phone:425-242-1662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00004420172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist