1720181100 NPI number — MRS. SUSAN CHAPMAN HENNIGAN PT

Table of content: MRS. SUSAN CHAPMAN HENNIGAN PT (NPI 1720181100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720181100 NPI number — MRS. SUSAN CHAPMAN HENNIGAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNIGAN
Provider First Name:
SUSAN
Provider Middle Name:
CHAPMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SLOAS
Provider Other First Name:
SUSAN
Provider Other Middle Name:
CHAPMAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720181100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 BLANCO ST
Provider Second Line Business Mailing Address:
# 201
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-762-3243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
STE 100B
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-440-1441
Provider Business Practice Location Address Fax Number:
512-440-1448
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1148440 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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