Provider Demographics
NPI:1184023541
Name:PENNINGER, KRISTA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:PENNINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:1025 E WEST CONNECTOR
Practice Address - Street 2:STE 406
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8531
Practice Address - Country:US
Practice Address - Phone:770-384-1001
Practice Address - Fax:770-384-0333
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist