Healthcare Provider Details

I. General information

NPI: 1013068568
Provider Name (Legal Business Name): CHARLES ROBERT HENDRICKS JR. P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 US HIGHWAY 9 SUITE 1500
FREEHOLD NJ
07728-1383
US

IV. Provider business mailing address

10 JESSICA PL
MONMOUTH BEACH NJ
07750-1407
US

V. Phone/Fax

Practice location:
  • Phone: 732-625-2200
  • Fax: 732-625-2205
Mailing address:
  • Phone: 732-625-2200
  • Fax: 732-625-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA00767900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: