Provider Demographics
NPI:1235985391
Name:HENNESSY, ANN MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 30TH ST APT B45
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2978
Mailing Address - Country:US
Mailing Address - Phone:917-848-3594
Mailing Address - Fax:
Practice Address - Street 1:226 E 54TH ST STE 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4854
Practice Address - Country:US
Practice Address - Phone:917-848-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014210-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant