Provider Demographics
NPI:1407895550
Name:DENNISON, ANN D (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:D
Last Name:DENNISON
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6203
Mailing Address - Country:US
Mailing Address - Phone:717-790-9994
Mailing Address - Fax:717-790-9996
Practice Address - Street 1:102 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6203
Practice Address - Country:US
Practice Address - Phone:717-790-9994
Practice Address - Fax:717-790-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006197L225100000X
MD18380225100000X
PART002249A2255A2300X
PADAPT000397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112937Medicare PIN