Provider Demographics
NPI:1780068791
Name:HENDRICKS, ZACHARY WILLIAM (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:WILLIAM
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8113
Mailing Address - Country:US
Mailing Address - Phone:641-990-5854
Mailing Address - Fax:
Practice Address - Street 1:4445 HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-8113
Practice Address - Country:US
Practice Address - Phone:641-990-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0787532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer