Provider Demographics
NPI:1720181100
Name:HENNIGAN, SUSAN CHAPMAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CHAPMAN
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:CHAPMAN
Other - Last Name:SLOAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:911 BLANCO ST
Mailing Address - Street 2:# 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703
Mailing Address - Country:US
Mailing Address - Phone:512-762-3243
Mailing Address - Fax:
Practice Address - Street 1:1701 W BEN WHITE BLVD
Practice Address - Street 2:STE 100B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7646
Practice Address - Country:US
Practice Address - Phone:512-440-1441
Practice Address - Fax:512-440-1448
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1148440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
454834Medicare ID - Type Unspecified