Provider Demographics
NPI:1952339129
Name:HENSON, JODY A (PT)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:A
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 1:625 SCENERY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2042
Mailing Address - Country:US
Mailing Address - Phone:412-751-0040
Mailing Address - Fax:412-751-0041
Practice Address - Street 1:625 SCENERY DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2042
Practice Address - Country:US
Practice Address - Phone:412-751-0040
Practice Address - Fax:412-751-0041
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009166L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251570641OtherTAX ID
PA0015935850004Medicaid
PA396610Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER