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General NPI Number Information
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NPI Number | 1982170163
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Entity Type | Individual
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Provider Name | ELIZABETH A. PENROSE LMT
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 1098 STATE ROUTE 221
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City | MARATHON
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State | NY
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Zip | 13803-1108
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Country | US
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Telephone | 607-662-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 87 W MAIN ST
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City | DRYDEN
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State | NY
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Zip | 13053-8706
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Country | US
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Telephone | 607-844-3304
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 031140
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License Number State | NY
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