Provider Demographics
NPI:1932908837
Name:HENRICKSEN PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:HENRICKSEN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER /PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRICKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-789-5384
Mailing Address - Street 1:4250 MARTIN WAY E STE 105
Mailing Address - Street 2:PMB 236
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5317
Mailing Address - Country:US
Mailing Address - Phone:360-789-5384
Mailing Address - Fax:360-918-9713
Practice Address - Street 1:3721 GRIFFIN LN SE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2192
Practice Address - Country:US
Practice Address - Phone:360-789-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy