Provider Demographics
NPI:1396037115
Name:PENZATO, BARBARA ANN (MPT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:PENZATO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1707
Mailing Address - Country:US
Mailing Address - Phone:630-675-9171
Mailing Address - Fax:
Practice Address - Street 1:964 N 5TH AVE
Practice Address - Street 2:BLDG C
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1204
Practice Address - Country:US
Practice Address - Phone:630-443-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.009256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist