Individual
DUSTIN BLAKE HENDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
590 S 5TH AVE, LEBANON, PA 17042-9195
(717) 274-0421
Mailing address
701 READING AVE APT 412, WEST READING, PA 19611-1284
(434) 774-6720
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT028190
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT028190
PHYSICAL THERAPIST STATE LICENSE
PA
Enumeration date
04/16/2020
Last updated
04/16/2020
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