Provider Demographics
NPI:1528847985
Name:TESTERMAN, PENNY ANN (LMT)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:ANN
Last Name:TESTERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N US HWY 441 # 1106
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3194
Mailing Address - Country:US
Mailing Address - Phone:540-871-2140
Mailing Address - Fax:
Practice Address - Street 1:16811 SE 142ND CT
Practice Address - Street 2:
Practice Address - City:WEIRSDALE
Practice Address - State:FL
Practice Address - Zip Code:32195-2541
Practice Address - Country:US
Practice Address - Phone:540-871-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist