Provider Demographics
NPI:1639324494
Name:PENOLI, AMELIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:PENOLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 BEE CAVE RD
Mailing Address - Street 2:BLDG 3, STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-6135
Mailing Address - Country:US
Mailing Address - Phone:512-306-8007
Mailing Address - Fax:512-672-6178
Practice Address - Street 1:9433 BEE CAVE RD
Practice Address - Street 2:BLDG 3, STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-6135
Practice Address - Country:US
Practice Address - Phone:512-306-8007
Practice Address - Fax:512-672-6178
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist