Provider Demographics
NPI:1184047052
Name:HEINZ, PENNY SUZANNE (LPTA,LMT,NASM-CPT)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:SUZANNE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:LPTA,LMT,NASM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 AMERICAN EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5284
Mailing Address - Country:US
Mailing Address - Phone:813-634-1668
Mailing Address - Fax:813-634-9578
Practice Address - Street 1:1010 AMERICAN EAGLE BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5284
Practice Address - Country:US
Practice Address - Phone:813-634-1668
Practice Address - Fax:813-634-9578
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA15676225200000X
FLMA31177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist