Provider Demographics
NPI:1508202680
Name:HENDRIKS, BEN GERARD (PT)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:GERARD
Last Name:HENDRIKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 S HIGHWAY 85 # 87
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1463
Mailing Address - Country:US
Mailing Address - Phone:719-391-0044
Mailing Address - Fax:
Practice Address - Street 1:5520 S HIGHWAY 85 # 87
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1463
Practice Address - Country:US
Practice Address - Phone:719-391-0044
Practice Address - Fax:719-391-0012
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist