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General NPI Number Information
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NPI Number | 1104121821
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Entity Type | Individual
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Provider Name | BRIAN MATTHEW HENDLEY PT
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Gender | Male
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 2990 HWY 49S SUITE A
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City | FLORENCE
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State | MS
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Zip | 39073
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Country | US
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Telephone | 601-891-8179
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Fax | 601-891-8520
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Provider Business Mailing Address
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Address Line | 921 W BEACON STREET
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City | PHILADELPHIA
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State | MS
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Zip | 39350
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Country | US
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Telephone | 601-650-0002
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Fax | 601-650-9902
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 640881013
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT2731
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License Number State | MS
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