Provider Demographics
NPI:1659715407
Name:CHRISTINE M. HENDRY PHYSICAL THERAPY LAC PC
Entity Type:Organization
Organization Name:CHRISTINE M. HENDRY PHYSICAL THERAPY LAC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT LAC
Authorized Official - Phone:619-255-4477
Mailing Address - Street 1:1807 ROBINSON AVE
Mailing Address - Street 2:104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7633
Mailing Address - Country:US
Mailing Address - Phone:619-255-4477
Mailing Address - Fax:619-255-4499
Practice Address - Street 1:1807 ROBINSON AVE
Practice Address - Street 2:104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7633
Practice Address - Country:US
Practice Address - Phone:619-255-4477
Practice Address - Fax:619-255-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11398261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy