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NPI Code Detail

MEDICARE: THERESA HENDRICKS PT

MEDICARE: THERESA HENDRICKS PT
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
1225100000XPhysical Therapist38979CA

General Provider Information

NPI Number : 1952546244
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA HENDRICKS PT
Provider Business Mailing Address
First Line : 235 NUTMEG ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-6201
Country : US
Telephone Number : 757-812-5701
Fax Number :
Provider Business Practice Location Address
First Line : 235 NUTMEG ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-6201
Country : US
Telephone Number : 757-812-5701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2008
Last Update Date : 01/21/2013

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Directions to “ THERESA HENDRICKS PT” Practice Location

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