Provider Demographics
NPI:1356481998
Name:HENDRICKSON, PAUL NORMAN (CP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:NORMAN
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 FILLMORE ST
Mailing Address - Street 2:GL5
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1514
Mailing Address - Country:US
Mailing Address - Phone:303-316-2615
Mailing Address - Fax:303-331-9019
Practice Address - Street 1:1633 FILLMORE ST
Practice Address - Street 2:GL5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1514
Practice Address - Country:US
Practice Address - Phone:303-316-2615
Practice Address - Fax:303-331-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98928783Medicaid