Provider Demographics
NPI:1558320309
Name:HENDRICKSON, CHRISTINA (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:COGORNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 TERRE VERTE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1217
Mailing Address - Country:US
Mailing Address - Phone:314-328-5553
Mailing Address - Fax:314-328-5610
Practice Address - Street 1:25 TERRE VERTE CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-1217
Practice Address - Country:US
Practice Address - Phone:314-328-5553
Practice Address - Fax:314-328-5610
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006000394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00286707OtherRAILROAD MEDICARE
MO221124038Medicare ID - Type Unspecified
MOP00286707OtherRAILROAD MEDICARE