Provider Demographics
NPI:1942638986
Name:HENNESSEY, DILLON MICHAEL
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:MICHAEL
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 DICK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6420
Mailing Address - Country:US
Mailing Address - Phone:406-750-1779
Mailing Address - Fax:
Practice Address - Street 1:36 DICK RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6420
Practice Address - Country:US
Practice Address - Phone:406-750-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant