MEDICARE: MRS. STEPHANIE L HENRIKSEN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	P1 60230110	WA

General Provider Information

NPI Number	:	1639514599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE L HENRIKSEN PTA

Provider Business Mailing Address
First Line	:	2517 5TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-1515
Country	:	US
Telephone Number	:	206-351-8916
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 5TH AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-1515
Country	:	US
Telephone Number	:	206-351-8916
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	05/06/2013

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