Provider Demographics
NPI:1285884551
Name:HENNESSY, KATHLEEN JANE (DPT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JANE
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:JANE
Other - Last Name:CARLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:21514 CORMORANT COVE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7523
Mailing Address - Country:US
Mailing Address - Phone:813-995-9575
Mailing Address - Fax:
Practice Address - Street 1:21514 CORMORANT COVE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7523
Practice Address - Country:US
Practice Address - Phone:813-482-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist