Provider Demographics
NPI:1639147994
Name:HEKKER, HENDRIKA LC (PT)
Entity Type:Individual
Prefix:MRS
First Name:HENDRIKA
Middle Name:LC
Last Name:HEKKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 MINT BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-8808
Mailing Address - Country:US
Mailing Address - Phone:641-209-6446
Mailing Address - Fax:641-209-9590
Practice Address - Street 1:309 W HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2810
Practice Address - Country:US
Practice Address - Phone:641-209-6446
Practice Address - Fax:641-209-9590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17221OtherWELLMARK
IA0207621Medicaid
IA17221OtherWELLMARK