Healthcare Provider Details

I. General information

NPI: 1366463176
Provider Name (Legal Business Name): RICHARD HENDRICKS PT,DPT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56171 E COLFAX #6
STRASBURG CO
80136
US

IV. Provider business mailing address

56171 E COLFAX #6
STRASBURG CO
80136
US

V. Phone/Fax

Practice location:
  • Phone: 303-622-6688
  • Fax:
Mailing address:
  • Phone: 303-622-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7419
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: