Provider Demographics
NPI:1740480110
Name:PENROSE & ASSOCIATES PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PENROSE & ASSOCIATES PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:PENROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-456-1444
Mailing Address - Street 1:1445 GALAXY DR NE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4746
Mailing Address - Country:US
Mailing Address - Phone:360-456-1444
Mailing Address - Fax:360-456-1883
Practice Address - Street 1:1445 GALAXY DR NE
Practice Address - Street 2:SUITE 301
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4746
Practice Address - Country:US
Practice Address - Phone:360-456-1444
Practice Address - Fax:360-456-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008404261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy