Provider Demographics
NPI:1669505061
Name:HENDRYX, JAMIE L (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:HENDRYX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:WILDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:548 RUNNING W DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-2074
Mailing Address - Country:US
Mailing Address - Phone:307-696-6045
Mailing Address - Fax:307-696-6046
Practice Address - Street 1:548 RUNNING W DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-2074
Practice Address - Country:US
Practice Address - Phone:307-696-6045
Practice Address - Fax:307-696-6046
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist