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General NPI Number Information
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NPI Number | 1861941643
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Entity Type | Individual
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Provider Name | DONALD PENNY
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Gender | Male
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 85072 CREWS RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1556
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Country | US
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Telephone | 904-574-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 85072 CREWS RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1556
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Country | US
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Telephone | 904-574-7477
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-1222
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 226000000X
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Taxonomy Name | Recreational Therapist Assistant
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License Number | PTA26290
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License Number State | FL
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