Individual
MRS. MARY E HENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5505 NEW COPELAND RD, TYLER, TX 75703-3955
(903) 939-2443
Mailing address
5505 NEW COPELAND RD, TYLER, TX 75703-3955
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2021176
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021176
PTA LISCENSE
TX
Enumeration date
08/30/2018
Last updated
08/30/2018
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