Provider Demographics
NPI:1205304946
Name:SCHELLINGER, PENELOPE ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:ANN
Last Name:SCHELLINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:ANN
Other - Last Name:FOSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2196 MAXIMILIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19091 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4982
Practice Address - Country:US
Practice Address - Phone:352-279-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22543225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant