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General NPI Number Information
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NPI Number | 1598820524
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Entity Type | Organization
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Legal Business Name | M KEN HEDRICK PC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 201 E CURTIS ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2678
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Country | US
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Telephone | 864-275-0669
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Fax | 864-967-3166
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Provider Business Mailing Address
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Address Line | 19 BROOKHAVEN WAY
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-1983
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Country | US
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Telephone | 864-275-0669
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Fax | 864-976-3166
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MR. M KEN HEDRICK
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Credential | MPT
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Telephone | 864-275-0669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3686
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License Number State | SC
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