Healthcare Provider Details

I. General information

NPI: 1548822059
Provider Name (Legal Business Name): ABBY JOY HENDRYX PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY JOY GARRETT

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MAIN ST
PHILOMATH OR
97370-9725
US

IV. Provider business mailing address

300 BOULDER FALLS DR APT E218
LEBANON OR
97355-2883
US

V. Phone/Fax

Practice location:
  • Phone: 541-929-2255
  • Fax:
Mailing address:
  • Phone: 509-855-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number63266
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: