Provider Demographics
NPI:1568931848
Name:BADGER, PENELOPE SUE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:SUE
Last Name:BADGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S LINCOLN ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-2461
Mailing Address - Country:US
Mailing Address - Phone:717-641-3278
Mailing Address - Fax:
Practice Address - Street 1:3026 MOUNT HOPE HOME RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-9529
Practice Address - Country:US
Practice Address - Phone:665-636-6365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003107225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant