Provider Demographics
NPI:1225348717
Name:HENSHAW, GARRET W (ATC)
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:W
Last Name:HENSHAW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 BLANCH AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1906
Mailing Address - Country:US
Mailing Address - Phone:201-981-0755
Mailing Address - Fax:
Practice Address - Street 1:FOREST HILLS PARKWAY
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721
Practice Address - Country:US
Practice Address - Phone:732-269-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001621002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer