Provider Demographics
NPI:1831330190
Name:REYNOLDS, PENNY K (CMT, NMT, NCTMB)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:K
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CMT, NMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-1810
Mailing Address - Country:US
Mailing Address - Phone:406-452-9193
Mailing Address - Fax:
Practice Address - Street 1:232 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1810
Practice Address - Country:US
Practice Address - Phone:406-452-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist