Healthcare Provider Details

I. General information

NPI: 1588681480
Provider Name (Legal Business Name): KAREN JEAN PENNY KINESIOTHERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3620
US

IV. Provider business mailing address

1367 JONES RD
RENTZ GA
31075-3531
US

V. Phone/Fax

Practice location:
  • Phone: 478-277-2760
  • Fax:
Mailing address:
  • Phone: 478-277-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number973
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: