Provider Demographics
NPI:1740434828
Name:HENDRICKS, JENNIFER D (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:BUTERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 26044
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824
Mailing Address - Country:US
Mailing Address - Phone:315-437-4689
Mailing Address - Fax:315-437-4698
Practice Address - Street 1:171 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2548
Practice Address - Country:US
Practice Address - Phone:315-437-4689
Practice Address - Fax:315-437-4698
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018457-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics