Provider Demographics
NPI:1578244612
Name:HENDRICKSON, MICHAEL CARL (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARL
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16560 WEDGE PKWY # 200A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3318
Mailing Address - Country:US
Mailing Address - Phone:775-384-1400
Mailing Address - Fax:
Practice Address - Street 1:4878 SPARKS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-8150
Practice Address - Country:US
Practice Address - Phone:775-507-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist