MEDICARE: MS. ARLENE SUSAN HENDRICKS RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	003992	CT

General Provider Information

NPI Number	:	1619526506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARLENE SUSAN HENDRICKS RPT

Provider Business Mailing Address
First Line	:	6 SHERWOOD LN
Second Line	:
City	:	MARLBOROUGH
State	:	CT
Zip	:	06447-1456
Country	:	US
Telephone Number	:	860-729-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 NORTH RD
Second Line	:
City	:	WINDHAM
State	:	CT
Zip	:	06280-1311
Country	:	US
Telephone Number	:	860-423-4636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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