Provider Demographics
NPI:1548551575
Name:POWER, PENELOPE (LMP)
Entity type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:
Last Name:POWER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 50TH STREET CT NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8589
Mailing Address - Country:US
Mailing Address - Phone:253-444-8034
Mailing Address - Fax:
Practice Address - Street 1:3214 50TH STREET CT NW
Practice Address - Street 2:SUITE 204
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8589
Practice Address - Country:US
Practice Address - Phone:253-444-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60153810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist