Provider Demographics
NPI:1679786610
Name:HENSEL, HEIDI RENAE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:RENAE
Last Name:HENSEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6487 YELLOW JACKET
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-7461
Mailing Address - Country:US
Mailing Address - Phone:760-937-1601
Mailing Address - Fax:
Practice Address - Street 1:152 PIONEER LN STE D
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2563
Practice Address - Country:US
Practice Address - Phone:760-873-8220
Practice Address - Fax:760-873-4443
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT163010Medicare ID - Type Unspecified