MEDICARE: PENNY GARRETT P.T,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	03175	IA

General Provider Information

NPI Number	:	1629198957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY GARRETT P.T,

Provider Business Mailing Address
First Line	:	31169 462ND AVE
Second Line	:
City	:	VERMILLION
State	:	SD
Zip	:	57069-6711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 MORNINGSIDE AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-1716
Country	:	US
Telephone Number	:	712-222-6396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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Directions to “ PENNY GARRETT P.T,” Practice Location

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