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Individual
TRACY LYNN HENDERSHOTT
Active
Individual
TRACY LYNN HENDERSHOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00005971
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0168528
LABOR AND INDUSTRIES
WA
01
—
4304HE
BLUE SHIELD
—
05
—
8341588
—
WA
01
—
8932338
CRIME VICTIMS INSURANCE
WA
01
—
911400843
BLUE CROSS
—
Enumeration date
07/10/2006
Last updated
08/10/2010
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