Provider Demographics
NPI:1427086529
Name:HENSLEY, MARY B
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:B
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 SE ISABELL RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8865
Mailing Address - Country:US
Mailing Address - Phone:772-335-7073
Mailing Address - Fax:772-398-2632
Practice Address - Street 1:2071 SE ISABELL RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8865
Practice Address - Country:US
Practice Address - Phone:772-335-7073
Practice Address - Fax:772-398-2632
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 4729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist