Provider Demographics
NPI:1548409600
Name:HENSLEE, MELINDA MARI (PTA)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:MARI
Last Name:HENSLEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MARI
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5606 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-1260
Mailing Address - Country:US
Mailing Address - Phone:870-718-9090
Mailing Address - Fax:
Practice Address - Street 1:3450 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5508
Practice Address - Country:US
Practice Address - Phone:870-534-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1632225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant