Provider Demographics
NPI:1659680544
Name:PENN, JOANNE (MT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 AZTEC DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1916
Mailing Address - Country:US
Mailing Address - Phone:952-224-0607
Mailing Address - Fax:
Practice Address - Street 1:8901 AZTEC DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1916
Practice Address - Country:US
Practice Address - Phone:952-224-0607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist