Healthcare Provider Details

I. General information

NPI: 1700302858
Provider Name (Legal Business Name): DANIEL S HENSLEY PA-C, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BETHLEHEM PIKE
COLMAR PA
18915-9719
US

IV. Provider business mailing address

103 BETHLEHEM PIKE
COLMAR PA
18915-9719
US

V. Phone/Fax

Practice location:
  • Phone: 215-257-3700
  • Fax:
Mailing address:
  • Phone: 215-257-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066612
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberRTRT005702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: