MEDICARE: ASHLEY LYNN HENSLEY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A02902	KY
2	225200000X	Physical Therapy Assistant	PTA008729	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A02902	OTHER	KY	KENTUCKY BOARD OF PHYSICAL THERAPY
2	PTA008729	OTHER	OH	OHIO BOARD OF PHYSICAL THERAPY

General Provider Information

NPI Number	:	1386132157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNN HENSLEY PTA

Provider Business Mailing Address
First Line	:	2344 AMSTERDAM RD
Second Line	:
City	:	VILLA HILLS
State	:	KY
Zip	:	41017-3712
Country	:	US
Telephone Number	:	858-426-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 AMSTERDAM RD
Second Line	:
City	:	VILLA HILLS
State	:	KY
Zip	:	41017-3712
Country	:	US
Telephone Number	:	859-426-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2018
Last Update Date	:	04/27/2018

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