Healthcare Provider Details

I. General information

NPI: 1659327385
Provider Name (Legal Business Name): GREGORY PAUL HENKE LMT CNMT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35759 MERIDIAN RD
SCIO OR
97374-9771
US

IV. Provider business mailing address

35759 MERIDIAN RD
SCIO OR
97374-9771
US

V. Phone/Fax

Practice location:
  • Phone: 503-394-4777
  • Fax: 503-394-1059
Mailing address:
  • Phone: 503-394-4777
  • Fax: 503-394-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8011
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: