Provider Demographics
NPI:1558328682
Name:HENSEL, CHAD CHRISTEN (LPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:CHRISTEN
Last Name:HENSEL
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1827
Mailing Address - Country:US
Mailing Address - Phone:740-383-8022
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1050 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-8022
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2543206Medicaid
P00199429OtherTRAVELERS MEDICARE
OH000000351777OtherANTHEM
311704991OtherTAX ID
311704991OtherUNITED MINEWORKERS OF AME
311704991OtherTAX ID