Provider Demographics
NPI:1437109386
Name:HENSHAW, MARTHA L (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:HENSHAW
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 1:250 S MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4714
Mailing Address - Country:US
Mailing Address - Phone:928-777-8050
Mailing Address - Fax:928-443-9029
Practice Address - Street 1:250 S MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4714
Practice Address - Country:US
Practice Address - Phone:928-777-8050
Practice Address - Fax:928-443-9029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0187239OtherSTATE OF WA DOL
AZAZ0462680OtherBCBS
AZP00066789Medicare ID - Type UnspecifiedMEDICARE RAILROAD
AZAZ0462680OtherBCBS