Provider Demographics
NPI:1194426494
Name:HENSON, DAVID BRYAN (LPTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRYAN
Last Name:HENSON
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2284
Mailing Address - Country:US
Mailing Address - Phone:256-225-1744
Mailing Address - Fax:
Practice Address - Street 1:2781 CT SWITZER SR DR
Practice Address - Street 2:SUITE 404
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-205-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6786225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant