Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS010219 | PA |
NPI | 1326242785 |
---|---|
Provider Name | Dr. Jan T Hendryx |
First Address | Erie, PA 16505-2571 |
Second Address | Erie, PA 16509-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 05/01/2017 |