Provider Demographics
NPI:1396473872
Name:HENNESSY SMITH, EMMA GWYNNE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GWYNNE
Last Name:HENNESSY SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 HARBOR POINTE DR APT 10
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5611
Mailing Address - Country:US
Mailing Address - Phone:864-349-9218
Mailing Address - Fax:
Practice Address - Street 1:7800 RIVERS AVE STE 1240
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4067
Practice Address - Country:US
Practice Address - Phone:843-277-0710
Practice Address - Fax:843-573-7412
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist