Provider Demographics
NPI:1093034449
Name:HENNESSY, PATRICIA J (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MARTHART AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2413
Mailing Address - Country:US
Mailing Address - Phone:610-446-8888
Mailing Address - Fax:
Practice Address - Street 1:100 E MARTHART AVE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2413
Practice Address - Country:US
Practice Address - Phone:610-446-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003650L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist