Provider Demographics
NPI:1952576712
Name:PENBERG, JOAN (PT)
Entity Type:Individual
Prefix:MISS
First Name:JOAN
Middle Name:
Last Name:PENBERG
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 1:5728 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2664
Mailing Address - Country:US
Mailing Address - Phone:301-879-6086
Mailing Address - Fax:301-879-6195
Practice Address - Street 1:11921 BOURNEFIELD WAY STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7815
Practice Address - Country:US
Practice Address - Phone:301-879-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist