Provider Demographics
NPI:1508136771
Name:HENDRY, CHRISTINE MARIE (LAC, PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:HENDRY
Suffix:
Gender:F
Credentials:LAC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1412 10TH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2945
Mailing Address - Country:US
Mailing Address - Phone:619-972-6138
Mailing Address - Fax:
Practice Address - Street 1:1807 ROBINSON AVE
Practice Address - Street 2:104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7633
Practice Address - Country:US
Practice Address - Phone:619-255-4477
Practice Address - Fax:619-255-4499
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9258171100000X
CA11398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-2581386OtherEIN