Healthcare Provider Details

I. General information

NPI: 1376015503
Provider Name (Legal Business Name): BLAINE HENDRICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 HIGHWAY 70 S STE 210
NASHVILLE TN
37221-1758
US

IV. Provider business mailing address

PO BOX 681478
FRANKLIN TN
37068-1478
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-1420
  • Fax: 615-673-1421
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: