Provider Demographics
NPI:1922558493
Name:HENSLEY, JAMES OWEN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:OWEN
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 MARTHA GLASS DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2075
Mailing Address - Country:US
Mailing Address - Phone:615-509-6822
Mailing Address - Fax:
Practice Address - Street 1:1646 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2204
Practice Address - Country:US
Practice Address - Phone:615-509-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000019692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer