Provider Demographics
NPI:1801961594
Name:HENDRIX, GRACE KROLL (PT)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:KROLL
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:B
Other - Middle Name:GRACE
Other - Last Name:KROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5940 MELLO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2911
Mailing Address - Country:US
Mailing Address - Phone:702-336-3310
Mailing Address - Fax:702-645-7422
Practice Address - Street 1:5940 MELLO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2911
Practice Address - Country:US
Practice Address - Phone:702-336-3310
Practice Address - Fax:702-645-7422
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist