Individual
MR. GUSTAV LUKE HENSEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSSM, ATC, SCC
Contact information
Practice address
501 ROUTE 447, NEWFOUNDLAND, PA 18445-5296
(570) 766-5995
Mailing address
501 ROUTE 447, NEWFOUNDLAND, PA 18445-5296
(570) 766-5995
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
25MT00139700
NJ
2255A2300X
Athletic Trainer
Primary
RT005334
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080102002
NATIONAL ATHLETIC TRAINERS' ASSOCIATION CERTIFICATION NUMBER
—
01
—
25MT00139700
NEW JERSEY OFFICE OF THE ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS
NJ
01
—
RT005334
PENNSYLVANIA STATE BOARD OF MEDICAL EXAMINERS
PA
Enumeration date
02/16/2006
Last updated
05/12/2020
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