Provider Demographics
NPI:1033110986
Name:HENDRICKS, TAMI SUE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:SUE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 AUDUBON CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-2970
Mailing Address - Country:US
Mailing Address - Phone:916-427-0223
Mailing Address - Fax:
Practice Address - Street 1:7200 S LAND PARK DR
Practice Address - Street 2:300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3612
Practice Address - Country:US
Practice Address - Phone:916-391-5010
Practice Address - Fax:916-391-5017
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21147ZMedicare ID - Type UnspecifiedGROUP MEDICARE ID
CA0PT121500Medicare ID - Type UnspecifiedINDIVID. PROVIDER ID