Provider Demographics
NPI:1821369844
Name:PENNINGTON, TOM A (PT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:A
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BELMONT BLVD
Mailing Address - Street 2:#304
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4508
Mailing Address - Country:US
Mailing Address - Phone:270-320-8002
Mailing Address - Fax:
Practice Address - Street 1:2101 BELMONT BLVD
Practice Address - Street 2:#304
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4508
Practice Address - Country:US
Practice Address - Phone:270-320-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYLICENSE #001099OtherKY LICENSE 001099