Provider Demographics
NPI:1831495837
Name:PENNINGTON, CLAUDIA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARIE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 LAKE VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9045
Mailing Address - Country:US
Mailing Address - Phone:360-662-6241
Mailing Address - Fax:360-876-1666
Practice Address - Street 1:873 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4229
Practice Address - Country:US
Practice Address - Phone:360-876-1500
Practice Address - Fax:360-876-1666
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60168878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist