Provider Demographics
NPI:1174898613
Name:NEWMAN, PENNIE L (PT)
Entity type:Individual
Prefix:
First Name:PENNIE
Middle Name:L
Last Name:NEWMAN
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 1:1019 MAJESTIC DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-9000
Mailing Address - Country:US
Mailing Address - Phone:859-223-0488
Mailing Address - Fax:
Practice Address - Street 1:1019 MAJESTIC DR STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-9000
Practice Address - Country:US
Practice Address - Phone:859-223-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK058360Medicare PIN