Provider Demographics
NPI:1285974584
Name:HRENCHIR, HEIDI HENDERSON (LMP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:HENDERSON
Last Name:HRENCHIR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 SE 4TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-7085
Mailing Address - Country:US
Mailing Address - Phone:206-354-9644
Mailing Address - Fax:
Practice Address - Street 1:17821 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6420
Practice Address - Country:US
Practice Address - Phone:425-430-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60305013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist