Provider Demographics
NPI:1356688535
Name:HENSE, LUCILLE (PT)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:HENSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8636 E STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3785
Mailing Address - Country:US
Mailing Address - Phone:941-727-4100
Mailing Address - Fax:941-727-4112
Practice Address - Street 1:8636 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-727-4100
Practice Address - Fax:941-727-4112
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist