Provider Demographics
NPI:1255681334
Name:PENNINGTON, MARCIA L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:L
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-3020
Mailing Address - Country:US
Mailing Address - Phone:937-743-2099
Mailing Address - Fax:
Practice Address - Street 1:764 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3020
Practice Address - Country:US
Practice Address - Phone:937-743-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist