Provider Demographics
NPI:1407997778
Name:HEDRICK, PHILLIP LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:LEE
Last Name:HEDRICK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 POINSETT HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29613-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FURMAN UNIVERSITY
Practice Address - Street 2:3300 POINSETT HWY.
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29613-0002
Practice Address - Country:US
Practice Address - Phone:864-294-3532
Practice Address - Fax:864-294-3338
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer