Provider Demographics
NPI:1437676905
Name:HENDRICKS, DEBRA MICHELLE (LMT, CNA, AAS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MICHELLE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LMT, CNA, AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 DOWNING CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2315
Mailing Address - Country:US
Mailing Address - Phone:970-581-9674
Mailing Address - Fax:
Practice Address - Street 1:3318 DOWNING CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2315
Practice Address - Country:US
Practice Address - Phone:970-581-9674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist