Provider Demographics
NPI:1053470567
Name:HENDRICKS, PAUL JAMES (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 COPPERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3840
Mailing Address - Country:US
Mailing Address - Phone:512-261-8699
Mailing Address - Fax:512-261-2237
Practice Address - Street 1:1602 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5160
Practice Address - Country:US
Practice Address - Phone:512-261-8699
Practice Address - Fax:512-261-2237
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11115242251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1111524OtherSTATE PT LICENSE
TX611681Medicare PIN
TX1111524OtherSTATE PT LICENSE