Healthcare Provider Details

I. General information

NPI: 1528847985
Provider Name (Legal Business Name): PENNY ANN TESTERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16811 SE 142ND CT
WEIRSDALE FL
32195-2541
US

IV. Provider business mailing address

720 N US HWY 441 # 1106
LADY LAKE FL
32159-3194
US

V. Phone/Fax

Practice location:
  • Phone: 540-871-2140
  • Fax:
Mailing address:
  • Phone: 540-871-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number66582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: