Provider Demographics
NPI:1467794727
Name:HENDRICKS, JULIE EDNA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:EDNA
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8655 HAVEN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4889
Mailing Address - Country:US
Mailing Address - Phone:800-642-5031
Mailing Address - Fax:909-989-7633
Practice Address - Street 1:8655 HAVEN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4889
Practice Address - Country:US
Practice Address - Phone:800-642-5031
Practice Address - Fax:909-989-7633
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist