Healthcare Provider Details

I. General information

NPI: 1457389330
Provider Name (Legal Business Name): ROBERT ALAN HENSON P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 51 & JANET STREET
PERRYOPOLIS PA
15473
US

IV. Provider business mailing address

ROUTE 51 & JANET STREET PO BOX 301
PERRYOPOLIS PA
15473
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-7415
  • Fax: 724-736-7416
Mailing address:
  • Phone: 724-736-7415
  • Fax: 724-736-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT02844L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: