Provider Demographics
NPI:1629395611
Name:HENDRIX, BRITNI NICHOLE (PTA)
Entity Type:Individual
Prefix:
First Name:BRITNI
Middle Name:NICHOLE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 N LELAND DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9348
Mailing Address - Country:US
Mailing Address - Phone:812-683-4090
Mailing Address - Fax:
Practice Address - Street 1:1712 N LELAND DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9348
Practice Address - Country:US
Practice Address - Phone:812-683-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003540A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06003540AOtherPTA LICENSE