Provider Demographics
NPI:1316682016
Name:HENSLEY, BRADLEY (MED, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 DIAMOND PKWY APT 325
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4350
Mailing Address - Country:US
Mailing Address - Phone:660-441-4538
Mailing Address - Fax:
Practice Address - Street 1:5030 HOLMES ST.
Practice Address - Street 2:#201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2499
Practice Address - Country:US
Practice Address - Phone:816-235-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180109112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer