Provider Demographics
NPI:1447980818
Name:HENSON, KRISTIN ALEXIS (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ALEXIS
Last Name:HENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ALEXIS
Other - Last Name:BUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7401 RIVERSIDE PKWY UNIT 219
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5057
Mailing Address - Country:US
Mailing Address - Phone:918-810-0263
Mailing Address - Fax:539-202-5007
Practice Address - Street 1:7401 RIVERSIDE PKWY UNIT 219
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5057
Practice Address - Country:US
Practice Address - Phone:918-810-0263
Practice Address - Fax:539-202-5007
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OK6137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist