Provider Demographics
NPI:1548646904
Name:PENNINGTON, EDDIE (PTA)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FAIRWAY AVE APT 3
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2472
Mailing Address - Country:US
Mailing Address - Phone:828-729-3633
Mailing Address - Fax:
Practice Address - Street 1:142 FAIRWAY AVE APT 3
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2472
Practice Address - Country:US
Practice Address - Phone:828-729-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5744225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant