Provider Demographics
NPI:1073175857
Name:HENNESSEY, LIAM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 W REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4577
Mailing Address - Country:US
Mailing Address - Phone:480-510-3546
Mailing Address - Fax:
Practice Address - Street 1:3970 E RIGGS RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5412
Practice Address - Country:US
Practice Address - Phone:480-883-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-30717OtherPHYSICAL THERAPY LICENSE