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General NPI Number Information
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NPI Number | 1003902776
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Entity Type | Individual
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Provider Name | WILLIAM HENSON
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 6610 BARDSTOWN RD
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City | LOUISVILLE
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State | KY
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Zip | 40291
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Country | US
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Telephone | 502-762-1243
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Fax | 502-762-9114
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Provider Business Mailing Address
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Address Line | 8100 WOODFERN WAY
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City | LOUISVILLE
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State | KY
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Zip | 40291
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Country | US
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Telephone | 502-592-6470
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT336
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License Number State | KY
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