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Individual

JIM T HENRICKSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1708 YAKIMA AVE, TACOMA, WA 98405-5307
(253) 274-4712
Mailing address
9505 S STEELE ST, TACOMA, WA 98444-6858
(253) 597-6800
(253) 597-6888

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00004025
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8392219
WA
Enumeration date
05/24/2007
Last updated
10/27/2022
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