Provider Demographics
NPI:1619035110
Name:FOLAND, PENNY WALTER (ATC)
Entity Type:Individual
Prefix:MISS
First Name:PENNY
Middle Name:WALTER
Last Name:FOLAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3604
Mailing Address - Country:US
Mailing Address - Phone:845-358-1710
Mailing Address - Fax:845-353-2147
Practice Address - Street 1:1 S BOULEVARD
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3604
Practice Address - Country:US
Practice Address - Phone:845-358-1710
Practice Address - Fax:845-353-2147
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer