Provider Demographics
NPI:1275893430
Name:DEJARNETTE, PENNY HELEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:HELEN
Last Name:DEJARNETTE
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 1:188 JESSAMINE PL
Mailing Address - Street 2:
Mailing Address - City:MCGAHEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22840-2105
Mailing Address - Country:US
Mailing Address - Phone:804-641-2848
Mailing Address - Fax:
Practice Address - Street 1:188 JESSAMINE PL
Practice Address - Street 2:
Practice Address - City:MCGAHEYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22840-2105
Practice Address - Country:US
Practice Address - Phone:804-641-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist