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General NPI Number Information
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NPI Number | 1154537033
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Entity Type | Individual
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Provider Name | NANCY PENROD MONNIE DPT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 16621 CHAMPION WAY SUITE 100
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City | SANDY
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State | OR
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Zip | 97055-7257
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Country | US
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Telephone | 503-668-5321
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Fax | 503-668-9742
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Provider Business Mailing Address
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Address Line | 1711 SE 26TH CT
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City | GRESHAM
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State | OR
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Zip | 97080-5291
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Country | US
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Telephone | 503-667-5880
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Fax | 503-669-6555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1094
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License Number State | OR
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