DUSTIN BLAKE HENDRICK (NPI# 1073133385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073133385 |
| Entity Type | Individual |
| Full Name | DUSTIN BLAKE HENDRICK |
| Credential | DPT |
| Practice Address |
590 S 5th Ave Lebanon PA 17042-9195 |
| Mailing Address |
701 Reading Ave Apt 412 West Reading PA 19611-1284 |
| Practice Telephone | 7172740421 |
| Mailing Telephone | 4347746720 |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2020-04-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251G0304X |
Physical Therapist Specialization: Geriatrics |
PT028190 | PA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | PHYSICAL THERAPIST STATE LICENSE | PT028190 | 01 |
| Street Address |
590 S 5TH AVE |
| City | LEBANON |
| State | PA |
| Zip Code | 17042-9195 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881602332 | Lebanon County Commissioners | Skilled Nursing Facility | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2006-08-03 |
| 1619504040 | Cedar Haven Operations LLC | Skilled Nursing Facility | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2020-03-25 |
| 1558837138 | Janet Irene Chicka | Occupational Therapist | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2018-10-22 |
| 1629544408 | Deitra Meaghan Hood | Occupational Therapy Assistant | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2018-10-18 |
| 1902384787 | Georgia M Cleary | Occupational Therapist | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2018-08-02 |
| 1649689423 | Cedar Haven Acquisition LLC | Nursing Facility/Intermediate Care Facility | 590 S 5th Ave, Lebanon, PA 17042-9195 | 2014-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023676384 | Sandra L Pistone | Registered Nurse | 905 S. 2nd Ave, Lebanon, PA 17042 | 2019-06-03 |
| 1154848414 | Kihc, LLC | Home Health | 900-c Centerville Road, Suite C, Lancaster, PA 17042 | 2017-08-28 |
| 1316301724 | Good Samaritan Physician Services | Radiology | 844 Tuck Street, Lebanon, PA 17042 | 2016-04-12 |
| 1609265883 | Ashley Hess | Behavioral Analyst | 15th South 9th Street, Lebanon, PA 17042 | 2015-01-12 |
| 1932504727 | Anthony Salvadore Petrole | Physician Assistant | 252 4th Street, Lebanon, PA 17042 | 2014-10-23 |
| 1801209713 | Matthew Johnson | Family Medicine | 920 Church Street, Lebanon, PA 17042 | 2014-06-09 |
| 1437414505 | Odalys Gonzalez-rodriguez | Physical Therapist | 1700 S Lincoln Ave., Lebanon Vmac Bldg 102 Room 120, Lebanon, PA 17042 | 2012-07-05 |
| 1750677175 | Anita Lyn Stokes | Speech-Language Pathologist | 1126 Walnut Street, Lebanon, PA 17042 | 2011-06-23 |
| 1205126497 | Karey Lynn Foote | Pharmacist | 415 S. 9th St, Lebanon, PA 17042 | 2011-04-09 |
| 1013227685 | T. W. Ponessa and Associates Counseling Services, Inc. | Community/Behavioral Health | 101 E. Evergreen Road, Lebanon, PA 17042 | 2010-10-18 |
| Find all providers in zip 17042 | ||||
| Taxonomy Code | 2251G0304X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Geriatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982736906 | Krystina Baumgarten | Physical Therapist | 24 Old Etna Rd, Lebanon, NH 03766 | 2007-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003382334 | Doriean Broady | Physical Therapist | 4902 Arch St Unit 1, Philadelphia, PA 19139-2727 | 2018-10-14 |
| 1790286680 | Shayla J Brown | Physical Therapist | 5928 Old French Rd Unit 3, Erie, PA 16509-3656 | 2018-02-26 |
| 1275033656 | Marika Desanctis | Physical Therapist | 2955 Adams Way, Riegelsville, PA 18077 | 2018-02-13 |
| 1871020438 | Andrew Lam | Physical Therapist | 8720 Verree Rd, Philadelphia, PA 19115-3610 | 2017-05-15 |
| 1144683111 | Rachana Sachdeva | Physical Therapist | 440 York Rd, Jenkintown, PA 19046-2853 | 2016-03-29 |
| 1184092926 | Ellen G Kalikow | Physical Therapist | 1787 Oak Hill Dr, Huntingdon Valley, PA 19006-7727 | 2015-09-10 |
| 1538536321 | Kristina Grande | Physical Therapist | 101 Cheyenne Dr, Old Forge, PA 18518-1581 | 2015-08-27 |
| 1740677848 | Regina Anne Hoffman | Physical Therapist | 25 James Rd, Broomall, PA 19008-1409 | 2015-04-16 |
| 1740680065 | Dorothy Brown | Physical Therapist | 2836 W 33rd St, Erie, PA 16506-3306 | 2014-08-25 |
| 1700285251 | Sreenivas Paluvayi | Physical Therapist | 115 Brookfield Cir, Macungie, PA 18062-1144 | 2014-08-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.