Individual
MR. JELANI HENNESSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3600 WOODS WAY, STATE FARM, VA 23160-0002
(804) 598-4251
Mailing address
2336 AFTON AVE, RICHMOND, VA 23224-7902
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306604870
VA
225200000X
Physical Therapy Assistant
50520
CA
225200000X
Physical Therapy Assistant
5069
MD
Other
Enumeration date
11/01/2018
Last updated
05/22/2020
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