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General NPI Number Information
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NPI Number | 1275572661
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Entity Type | Individual
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Provider Name | KATHLEEN PENNOCK MS, PT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 10128 W BROAD ST BLDG III
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6761
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Country | US
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Telephone | 804-217-9210
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Fax | 804-217-9213
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Provider Business Mailing Address
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Address Line | 10128 W BROAD ST BLDG III
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6761
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Country | US
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Telephone | 804-217-9210
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Fax | 804-217-9213
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305202695
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305202695
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License Number State | VA
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