Provider Demographics
NPI:1952368631
Name:HEDRICK, MARTIN K (MPT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:K
Last Name:HEDRICK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 BROOKHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-1983
Mailing Address - Country:US
Mailing Address - Phone:864-275-0669
Mailing Address - Fax:864-751-5297
Practice Address - Street 1:19 BROOKHAVEN WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-1983
Practice Address - Country:US
Practice Address - Phone:864-275-0669
Practice Address - Fax:864-751-5297
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ533330281Medicare PIN
Q323687045Medicare PIN