Provider Demographics
NPI:1235377086
Name:SANFORD, PENNY LYNNE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LYNNE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:PENNY
Other - Middle Name:LYNNE
Other - Last Name:SENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:3121 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1937
Mailing Address - Country:US
Mailing Address - Phone:360-734-6760
Mailing Address - Fax:360-752-0660
Practice Address - Street 1:3121 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1937
Practice Address - Country:US
Practice Address - Phone:360-734-6760
Practice Address - Fax:360-752-0660
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist