Provider Demographics
NPI:1407058472
Name:HENSLEY, KYLE ADAM (MPT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ADAM
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2489
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-251-0421
Practice Address - Street 1:8115 MARKET ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8427
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-763-8804
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9450225100000X
NCP14856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP14856OtherNC PT LICENSE
102072369OtherOWCP FACILITY ID
NCP14856OtherNC PT LICENSE