Provider Demographics
NPI:1366463176
Name:HENDRICKS, RICHARD (PT,DPT,ATC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56171 E COLFAX
Mailing Address - Street 2:#6
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136
Mailing Address - Country:US
Mailing Address - Phone:303-622-6688
Mailing Address - Fax:
Practice Address - Street 1:56171 E COLFAX
Practice Address - Street 2:#6
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136
Practice Address - Country:US
Practice Address - Phone:303-622-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13172077Medicaid