Provider Demographics
NPI:1104708379
Name:HENDERSON, LINDSAY R (LMT)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 OLD KETTLE FALLS RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9755
Mailing Address - Country:US
Mailing Address - Phone:509-207-8268
Mailing Address - Fax:
Practice Address - Street 1:16278 N HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-9627
Practice Address - Country:US
Practice Address - Phone:509-207-8268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014722225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist