Healthcare Provider Details

I. General information

NPI: 1114041209
Provider Name (Legal Business Name): BRENDA HENDRICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E LINCOLN ST
WICHITA KS
67211-3821
US

IV. Provider business mailing address

2535 E LINCOLN ST
WICHITA KS
67211-3821
US

V. Phone/Fax

Practice location:
  • Phone: 316-687-9794
  • Fax:
Mailing address:
  • Phone: 316-687-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1103037
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: