Provider Demographics
NPI:1982957973
Name:HENNESSY, TADHG ANDREW (LMP)
Entity Type:Individual
Prefix:
First Name:TADHG
Middle Name:ANDREW
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20715 LARCH WAY APT 24
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6854
Mailing Address - Country:US
Mailing Address - Phone:206-678-3653
Mailing Address - Fax:
Practice Address - Street 1:20715 LARCH WAY APT 24
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6854
Practice Address - Country:US
Practice Address - Phone:206-678-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60284696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist