Provider Demographics
NPI:1275755597
Name:HENDRIX, KATHRYN SUE (LMT,CMT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:LMT,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2928
Mailing Address - Country:US
Mailing Address - Phone:315-374-2572
Mailing Address - Fax:315-461-7151
Practice Address - Street 1:7550 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2928
Practice Address - Country:US
Practice Address - Phone:315-374-2572
Practice Address - Fax:315-461-7151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012735-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist