Provider Demographics
NPI:1508986654
Name:PENNINGTON, SUZY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZY
Middle Name:
Last Name:PENNINGTON
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 1:568 UNIOLA DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3345
Mailing Address - Country:US
Mailing Address - Phone:843-347-8179
Mailing Address - Fax:843-347-8003
Practice Address - Street 1:2379 CYPRESS CIR
Practice Address - Street 2:KINGSTON REHAB CENTER-CMC
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8921
Practice Address - Country:US
Practice Address - Phone:843-347-8179
Practice Address - Fax:843-347-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist