Provider Demographics
NPI:1568522563
Name:MERRIMAN, PENNY JACQUELINE (MS PT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:JACQUELINE
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6953
Mailing Address - Country:US
Mailing Address - Phone:361-221-9490
Mailing Address - Fax:361-592-0276
Practice Address - Street 1:1724 S BRAHMA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6793
Practice Address - Country:US
Practice Address - Phone:361-595-4163
Practice Address - Fax:361-592-0276
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist