MEDICARE: MRS. HOLLY HENDRICKSON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	CP010267A	WV
2	225200000X	Physical Therapy Assistant	004400	OH

General Provider Information

NPI Number	:	1700083987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY HENDRICKSON PTA

Provider Business Mailing Address
First Line	:	28378 TORCH RD
Second Line	:
City	:	COOLVILLE
State	:	OH
Zip	:	45723-9706
Country	:	US
Telephone Number	:	740-373-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 WASHINGTON BLVD STE E
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-3501
Country	:	US
Telephone Number	:	740-423-3084
Fax Number	:	740-423-5600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/29/2025

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Directions to “ MRS. HOLLY HENDRICKSON PTA” Practice Location

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