Healthcare Provider Details

I. General information

NPI: 1184835431
Provider Name (Legal Business Name): ADRIA JUNE HENDRICKSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD SUITE NUMBER 640
DENVER CO
80246-1253
US

IV. Provider business mailing address

10475 DALE CIR
WESTMINSTER CO
80234-3532
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-4450
  • Fax: 303-320-6668
Mailing address:
  • Phone: 585-377-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: