Healthcare Provider Details

I. General information

NPI: 1225539364
Provider Name (Legal Business Name): CHRISTOPHER JAMES HENDRICKSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

901 LAKESHORE DR
ISHPEMING MI
49849-1367
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-2261
  • Fax:
Mailing address:
  • Phone: 906-485-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number5502003022
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: