Provider Demographics
NPI:1932431988
Name:PENNINGTON, MARK ALLEN (LMT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:LMT
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Mailing Address - Street 1:2670 N COLUMBUS ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8408
Mailing Address - Country:US
Mailing Address - Phone:740-687-4917
Mailing Address - Fax:740-205-8073
Practice Address - Street 1:2670 N COLUMBUS ST
Practice Address - Street 2:SUITE J
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8408
Practice Address - Country:US
Practice Address - Phone:740-687-4917
Practice Address - Fax:740-205-8073
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2016-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH13553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist