Provider Demographics
NPI:1841235116
Name:PENNEY, BAMBI S (PT)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:S
Last Name:PENNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:630-466-9240
Mailing Address - Fax:630-262-2643
Practice Address - Street 1:2700 KESLINGER RD
Practice Address - Street 2:SUITE C
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:630-262-2633
Practice Address - Fax:630-262-2643
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070003064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL70003064OtherLICENSE
ILK28199Medicare PIN
IL70003064OtherLICENSE