Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 973 | PA |
NPI | 1588681480 |
---|---|
Provider Name | Miss Karen Jean Penny |
First Address | Rentz, GA 31075-3531 |
Second Address | Dublin, GA 31021-3620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |