Provider Demographics
NPI:1932391497
Name:HENSLEY, JACLYN (PT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 RIDGE LEA RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1051
Mailing Address - Country:US
Mailing Address - Phone:716-819-2400
Mailing Address - Fax:716-819-2419
Practice Address - Street 1:4242 RIDGE LEA RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1051
Practice Address - Country:US
Practice Address - Phone:716-819-2400
Practice Address - Fax:716-819-2419
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027523-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02888255Medicaid