Provider Demographics
NPI:1225287600
Name:TUSSING, PENNY PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:PATRICIA
Last Name:TUSSING
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 1:30575 WOODWARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0980
Mailing Address - Country:US
Mailing Address - Phone:248-280-8550
Mailing Address - Fax:248-280-8571
Practice Address - Street 1:30575 WOODWARD AVENUE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0980
Practice Address - Country:US
Practice Address - Phone:248-280-8550
Practice Address - Fax:248-280-8571
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist