Provider Demographics
NPI:1508213026
Name:HENDRICKS, EMILY KENDALL (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KENDALL
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KENDALL
Other - Last Name:HUBBUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9118
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55480-9118
Mailing Address - Country:US
Mailing Address - Phone:931-381-2663
Mailing Address - Fax:281-380-0513
Practice Address - Street 1:1050 N JAMES M CAMPBELL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2754
Practice Address - Country:US
Practice Address - Phone:931-381-2663
Practice Address - Fax:931-490-1369
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024162Medicaid