Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 5502003022 | MI |
N | 213ES0000X | Sports Medicine | 5502003022 | MI |
Y | 225200000X | Physical Therapy Assistant |
NPI | 1225539364 |
---|---|
Provider Name | Christopher James Hendrickson |
First Address | Ishpeming, MI 49849-1367 |
Second Address | Ishpeming, MI 49849-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2018 |
Last Update Date | 23/02/2018 |