Provider Demographics
NPI:1457394660
Name:HENSON, EMILY S (RPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:HENSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:
Practice Address - Street 1:400 PAUL BRYANT DR E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2009
Practice Address - Country:US
Practice Address - Phone:205-345-0192
Practice Address - Fax:205-247-2194
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3604225100000X
ALPTH4364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523082Medicaid
AL51523082OtherBLUE CROSS BLUE SHIELD
AL051523082Medicaid
AL051523082Medicare ID - Type Unspecified