Healthcare Provider Details

I. General information

NPI: 1558628370
Provider Name (Legal Business Name): JAMIE L HENRY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N ADAMS ST
COULEE CITY WA
99115-0817
US

IV. Provider business mailing address

1012 E 40TH AVE
SPOKANE WA
99203-2910
US

V. Phone/Fax

Practice location:
  • Phone: 509-632-8668
  • Fax: 509-632-5761
Mailing address:
  • Phone: 509-991-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60278692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: