Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob D Henderson, PT, DPT

Individual provider Physical Therapist · NPI 1609482553

Jacob D Henderson, PT, DPT is a Physical Therapist in Private Practice in Bonney Lake, Washington. Qualified in 2020, 6 years ago. Practices with Kaiser Foundation Health Plan of Washington, a 1,519-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
6
Licensed in
WA
In the registry since
2020
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

21525 Hwy 410 E Ste B
Bonney Lake, WA 98391-4101
Phone: (253) 826-8520
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 301 S 320th St, Federal Way, WA 98003-5200 — (877) 751-2446

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT61095770 (WA)

Record details

NPI number1609482553
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedSeptember 16, 2020
Last updated in NPPESSeptember 10, 2025
Certification dateSeptember 10, 2025
Mailing address301 S 320th St, Federal Way, WA 98003-5200

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Kaiser Foundation Health Plan Of Washington — 1519 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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