Provider Demographics
NPI:1023239183
Name:HENKE, KENNETH PAUL (ATC, BA)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:HENKE
Suffix:
Gender:M
Credentials:ATC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-8505
Mailing Address - Country:US
Mailing Address - Phone:859-428-3731
Mailing Address - Fax:
Practice Address - Street 1:7570 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2324
Practice Address - Country:US
Practice Address - Phone:859-283-0707
Practice Address - Fax:859-647-3022
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT5082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer