Provider Demographics
NPI:1477614378
Name:HARKEY, PENNY E (PT, MSPT, IMC)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:E
Last Name:HARKEY
Suffix:
Gender:F
Credentials:PT, MSPT, IMC
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:E
Other - Last Name:PICKELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MSPT, IMC
Mailing Address - Street 1:13738 WEEPING WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6899
Mailing Address - Country:US
Mailing Address - Phone:904-607-6594
Mailing Address - Fax:
Practice Address - Street 1:2730 ISABELLA BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8001
Practice Address - Country:US
Practice Address - Phone:904-372-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007503225100000X
FLPT 240392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000954742HMedicaid
FL000149200Medicaid
GA000954742FMedicaid