Provider Demographics
NPI:1295980704
Name:PENNER, JEANNETT M (MPT)
Entity type:Individual
Prefix:MRS
First Name:JEANNETT
Middle Name:M
Last Name:PENNER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8862 BENDER ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264
Mailing Address - Country:US
Mailing Address - Phone:360-354-1115
Mailing Address - Fax:360-354-0321
Practice Address - Street 1:8862 BENDER ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264
Practice Address - Country:US
Practice Address - Phone:360-354-1115
Practice Address - Fax:360-354-0321
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist