Provider Demographics
NPI:1831214501
Name:PENZO, ANGELA M (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:PENZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 MERCHANT CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8489
Mailing Address - Country:US
Mailing Address - Phone:941-907-9250
Mailing Address - Fax:941-907-8280
Practice Address - Street 1:7311 MERCHANT CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8489
Practice Address - Country:US
Practice Address - Phone:941-907-9250
Practice Address - Fax:941-907-8280
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4919AMedicare ID - Type Unspecified