Healthcare Provider Details

I. General information

NPI: 1720876113
Provider Name (Legal Business Name): LINDARO RENEE PENFIELD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W OHIO ST
CLINTON MO
64735-2062
US

IV. Provider business mailing address

215 W OHIO ST
CLINTON MO
64735-2062
US

V. Phone/Fax

Practice location:
  • Phone: 660-864-3183
  • Fax:
Mailing address:
  • Phone: 660-864-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2013033107
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: