Provider Demographics
NPI:1194154591
Name:HENRICHSMEYER, CASSANDRA (PTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:HENRICHSMEYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 201ST ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4110
Mailing Address - Country:US
Mailing Address - Phone:267-230-8602
Mailing Address - Fax:
Practice Address - Street 1:2022 201ST ST E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4110
Practice Address - Country:US
Practice Address - Phone:267-230-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60354268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant