Healthcare Provider Details

I. General information

NPI: 1477614378
Provider Name (Legal Business Name): PENNY E HARKEY PT, MSPT, IMC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENNY E PICKELS PT, MSPT, IMC

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 ISABELLA BLVD SUITE 10
JACKSONVILLE BEACH FL
32250-8001
US

IV. Provider business mailing address

13738 WEEPING WILLOW WAY
JACKSONVILLE FL
32224-6899
US

V. Phone/Fax

Practice location:
  • Phone: 904-372-4070
  • Fax:
Mailing address:
  • Phone: 904-607-6594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007503
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 24039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: