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General NPI Number Information
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NPI Number | 1780926105
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Entity Type | Individual
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Provider Name | MICHELLE RENEE HENDRICKS PT
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Gender | Female
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Dates
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Enumeration Date | 03/24/2013
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Last Update Date | 05/25/2017
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Provider Practice Location Address
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Address Line | 4812 E 33RD ST
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City | TULSA
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State | OK
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Zip | 74135-2038
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Country | US
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Telephone | 918-622-4126
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Fax | 918-270-2398
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Provider Business Mailing Address
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Address Line | 27950 S HIGHWAY 125 UNIT 39
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City | MONKEY ISLAND
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State | OK
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Zip | 74331-3124
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Country | US
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Telephone | 913-956-9032
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2013008000
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11-04532
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5012
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License Number State | OK
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