Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1356481998 |
---|---|
Provider Name | Paul Norman Hendrickson |
First Address | Denver, CO 80206-1514 |
Second Address | Denver, CO 80206-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
98928783 | (05) | CO |