Provider Demographics
NPI:1336177260
Name:HENSON, JAMES B (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:HENSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:MEDICAL OFFICE BUILDING #105
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-466-8811
Mailing Address - Fax:412-466-1508
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:MEDICAL OFFICE BUILDING #105
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-466-8811
Practice Address - Fax:412-466-1508
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003577L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015935850002Medicaid
PA251570641OtherTAX ID
PA251570641OtherTAX ID