Healthcare Provider Details

I. General information

NPI: 1336590066
Provider Name (Legal Business Name): BRITTANY STEVENS PENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

IV. Provider business mailing address

8840 CYPRESS WATERS BLVD STE 300
COPPELL TX
75019-4630
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-5353
  • Fax:
Mailing address:
  • Phone: 763-242-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14788-24
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10326
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: