Provider Demographics
NPI:1134336548
Name:HENDRICKX, THOMAS ANDREW (MPT,OCS,CSCS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANDREW
Last Name:HENDRICKX
Suffix:
Gender:M
Credentials:MPT,OCS,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 SE BRISTOL ST
Mailing Address - Street 2:STE 104
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0746
Mailing Address - Country:US
Mailing Address - Phone:949-475-5777
Mailing Address - Fax:949-475-5779
Practice Address - Street 1:2290 SE BRISTOL ST
Practice Address - Street 2:STE 104
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0746
Practice Address - Country:US
Practice Address - Phone:949-475-5777
Practice Address - Fax:949-475-5779
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCTA20058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ3698Medicare UPIN