Provider Demographics
NPI:1063671410
Name:PENLAND, TINA BENNETT (LMBT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:BENNETT
Last Name:PENLAND
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WILLOW PEAK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-8341
Mailing Address - Country:US
Mailing Address - Phone:828-692-7041
Mailing Address - Fax:
Practice Address - Street 1:3754 BREVARD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-8752
Practice Address - Country:US
Practice Address - Phone:828-606-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7485225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist