Provider Demographics
NPI:1508052937
Name:HENSLER, KELLY A (DPT,OCS,CSCS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:HENSLER
Suffix:
Gender:F
Credentials:DPT,OCS,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1914
Mailing Address - Country:US
Mailing Address - Phone:262-767-9579
Mailing Address - Fax:262-767-9610
Practice Address - Street 1:204 S PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1914
Practice Address - Country:US
Practice Address - Phone:262-767-9579
Practice Address - Fax:262-767-9610
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6167024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist