Provider Demographics
NPI:1376182592
Name:HENDRICKSON, RACHAEL DANNIELLE (LMT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DANNIELLE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-1236
Mailing Address - Country:US
Mailing Address - Phone:812-460-1400
Mailing Address - Fax:812-460-1402
Practice Address - Street 1:3212 N 13TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-1236
Practice Address - Country:US
Practice Address - Phone:812-460-1400
Practice Address - Fax:812-460-1402
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21705998225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist