Provider Demographics
NPI:1609840123
Name:HENSLEY, LAVONDA ANN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LAVONDA
Middle Name:ANN
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 5069
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-9625
Mailing Address - Country:US
Mailing Address - Phone:479-650-1123
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 5069
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-9625
Practice Address - Country:US
Practice Address - Phone:479-650-1123
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant