Provider Demographics
NPI:1568679124
Name:HENSCHEL, NICHOLAS TIMOTHY (MPT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:TIMOTHY
Last Name:HENSCHEL
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 1:1616 VIEBAHN ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6409
Mailing Address - Country:US
Mailing Address - Phone:920-860-0643
Mailing Address - Fax:
Practice Address - Street 1:3431 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2938
Practice Address - Country:US
Practice Address - Phone:920-457-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10568024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40476700Medicaid