Doctor Name: | ALTHEA TIGGS PENN |
NPI Number: | 1184820797 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BSPT |
License Number: | PT003851 |
Business Practice Address: | 201 Lake Valley Dr Loganville, GA - 300527883 |
Business Phone Number: | 6789576897 |
Business Fax Number: | |
Mailing Address: | 201 Lake Valley Dr, LOGANVILLE |
State: | GA |
Postal Code: | 300527883 |
Phone Number: | 6789576897 |
Fax Number: | |
NPI Enumeration Date: | 06/21/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251N0400X |
License Number: | PT003851 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Neurology |
Taxonomy Definition: |