Provider Demographics
NPI:1710425103
Name:BANGS, PENNY (CTRS)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:BANGS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 E BROCK ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2211
Mailing Address - Country:US
Mailing Address - Phone:307-675-3270
Mailing Address - Fax:
Practice Address - Street 1:477 E BROCK ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-2211
Practice Address - Country:US
Practice Address - Phone:307-675-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist