Provider Demographics
NPI:1457389330
Name:HENSON, ROBERT ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
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:ROUTE 51 & JANET STREET
Mailing Address - Street 2:PO BOX 301
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473
Mailing Address - Country:US
Mailing Address - Phone:724-736-7415
Mailing Address - Fax:724-736-7416
Practice Address - Street 1:ROUTE 51 & JANET STREET
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473
Practice Address - Country:US
Practice Address - Phone:724-736-7415
Practice Address - Fax:724-736-7416
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
PAPT02844L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251570641OtherTAX ID
PA0015935850009Medicaid
PA251570641OtherTAX ID