Doctor Name: | TRAVIS LAMONT HENDRICKS |
NPI Number: | 1487911012 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | OT014442 |
Business Practice Address: | 1 Medical Center Blvd Chester, PA - 190133902 |
Business Phone Number: | 6104472000 |
Business Fax Number: | 6104476373 |
Mailing Address: | 1015 Chestnut St., Suite 1020 PHILADELPHIA |
State: | PA |
Postal Code: | 19107 |
Phone Number: | 2159557785 |
Fax Number: | 2159559362 |
NPI Enumeration Date: | 04/20/2012 |
NPI Last Update Date: | 07/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | OT014442 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |