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NPI Code Detail

MEDICARE: MR. KEITH JOHN HENSON

MEDICARE: MR. KEITH JOHN HENSON
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
1225100000XPhysical Therapist004602KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000340690OTHERKYBLUE CROSS

General Provider Information

NPI Number : 1598817785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH JOHN HENSON
Provider Business Mailing Address
First Line : 403 N MILES ST
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-1834
Country : US
Telephone Number : 270-360-9129
Fax Number : 270-234-8197
Provider Business Practice Location Address
First Line : 4331 CHURCHMAN AVE
Second Line : SUITE 102
City : LOUISVILLE
State : KY
Zip : 40215-1164
Country : US
Telephone Number : 502-366-1773
Fax Number : 502-366-3500
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2007
Last Update Date : 07/08/2007

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