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General NPI Number Information
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NPI Number | 1003204835
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Entity Type | Individual
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Provider Name | BRIANNA ALEXANDRIA HENDRA M.S., A.T., A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 01/01/2015
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 18601 MIDDLEBELT RD
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City | ROMULUS
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State | MI
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Zip | 48174-9290
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Country | US
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Telephone | 661-753-6579
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Fax |
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Provider Business Mailing Address
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Address Line | 998 E FOREST AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-3877
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Country | US
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Telephone | 661-753-6579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.004820
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001390
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License Number State | MI
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