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General NPI Number Information
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NPI Number | 1609482553
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Entity Type | Individual
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Provider Name | JACOB D HENDERSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 21525 HWY 410 E STE B
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City | BONNEY LAKE
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State | WA
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Zip | 98391-4101
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Country | US
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Telephone | 253-826-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S 320TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5200
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Country | US
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Telephone | 877-751-2446
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Fax | 866-559-3952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61095770
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License Number State | WA
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