Provider Demographics
NPI:1184746737
Name:PENROD, SUSANNA (LMT)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:PENROD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:SOKALOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 WILLIAMSON CT
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7974
Mailing Address - Country:US
Mailing Address - Phone:615-957-3075
Mailing Address - Fax:
Practice Address - Street 1:5119 VICTORIA CV
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6806
Practice Address - Country:US
Practice Address - Phone:615-661-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000030225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist