Provider Demographics
NPI:1831503556
Name:HENDRIX REHABILITATION & CONDITIONING SERVICE INC
Entity type:Organization
Organization Name:HENDRIX REHABILITATION & CONDITIONING SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-5479
Mailing Address - Street 1:852 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3104
Mailing Address - Country:US
Mailing Address - Phone:931-728-5479
Mailing Address - Fax:931-728-9937
Practice Address - Street 1:852 INTERSTATE DRIVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3104
Practice Address - Country:US
Practice Address - Phone:931-728-5479
Practice Address - Fax:931-728-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT7480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty