Healthcare Provider Details

I. General information

NPI: 1023192887
Provider Name (Legal Business Name): DAVID IRELAND HENSLEE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 PLAZA PKWY SUITE 302
WICHITA FALLS TX
76308-3886
US

IV. Provider business mailing address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

V. Phone/Fax

Practice location:
  • Phone: 940-691-1114
  • Fax: 940-691-1125
Mailing address:
  • Phone: 940-322-0771
  • Fax: 940-767-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1020949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: