Active NPI
Keith John Henson
- Physical Therapist
- Louisville, KY
National Provider Identifier
1598817785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004602
- Practice address
- 4331 Churchman Ave
Suite 102
Louisville, KY 40215-1164 - Phone
- (502) 366-1773
- Fax
- (502) 366-3500
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 004602 | KY | Primary |
Addresses
Primary practice location
4331 Churchman Ave
Suite 102
Louisville, KY 40215-1164
Mailing address
403 N Miles St
Elizabethtown, KY 42701-1834
Phone (270) 360-9129
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000340690 | Other | KY | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004602 | KY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabcare Group East, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598817785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 N MILES ST",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427011834",
"telephone_number": "270-360-9129",
"fax_number": "270-234-8197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4331 CHURCHMAN AVE",
"address_2": "SUITE 102",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402151164",
"telephone_number": "502-366-1773",
"fax_number": "502-366-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSON",
"first_name": "KEITH",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KY",
"license": "004602",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "000000340690",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.