Provider Demographics
NPI:1740594902
Name:HENDRIXSON, KELLEY JEAN
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:JEAN
Last Name:HENDRIXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:JEAN
Other - Last Name:HENDRIXSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:140 OLD SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357-7669
Mailing Address - Country:US
Mailing Address - Phone:931-635-3255
Mailing Address - Fax:
Practice Address - Street 1:140 OLD SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7669
Practice Address - Country:US
Practice Address - Phone:931-635-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist