Provider Demographics
NPI:1740733070
Name:HENNESSEY, PATRICK (DPT)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:HENNESSEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12807 HIGHWAY 90 STE 101
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-2214
Mailing Address - Country:US
Mailing Address - Phone:985-308-0078
Mailing Address - Fax:985-308-0248
Practice Address - Street 1:12807 HIGHWAY 90 STE 101
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-2214
Practice Address - Country:US
Practice Address - Phone:985-308-0078
Practice Address - Fax:985-308-0248
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09352225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist