Provider Demographics
NPI:1831126861
Name:HENSLEY, BRANDON DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 FOXHAVEN CT
Mailing Address - Street 2:#6
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-1093
Mailing Address - Country:US
Mailing Address - Phone:859-625-2605
Mailing Address - Fax:
Practice Address - Street 1:1663 FOXHAVEN CT
Practice Address - Street 2:#6
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-1093
Practice Address - Country:US
Practice Address - Phone:859-625-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer