Provider Demographics
NPI:1629690771
Name:HENNESSEY, CHAD PATRICK (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PATRICK
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WOOD MESA DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1254
Mailing Address - Country:US
Mailing Address - Phone:512-677-2896
Mailing Address - Fax:
Practice Address - Street 1:2211 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4514
Practice Address - Country:US
Practice Address - Phone:512-943-5000
Practice Address - Fax:512-943-5125
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT22952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer