Provider Demographics
NPI:1003204835
Name:HENDRA, BRIANNA ALEXANDRIA (MS, AT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:ALEXANDRIA
Last Name:HENDRA
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3877
Mailing Address - Country:US
Mailing Address - Phone:661-753-6579
Mailing Address - Fax:
Practice Address - Street 1:18601 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-9290
Practice Address - Country:US
Practice Address - Phone:661-753-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0048202255A2300X
MI26010013902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer