Individual
MR. JERRY LYNN HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
17644 140TH AVE NE, WOODINVILLE, WA 98072-6800
(425) 402-9772
(425) 402-9443
Mailing address
17644 140TH AVE NE, WOODINVILLE, WA 98072-6800
(425) 402-9772
(425) 402-9443
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00002471
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160454
L&I GROUP #
WA
01
—
19038
L&I PIN#
WA
05
—
7114150
—
WA
05
—
8323677
—
WA
Enumeration date
07/24/2006
Last updated
07/09/2007
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