Provider Demographics
NPI:1730418203
Name:SCHULKEN, PENNY MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:MARIE
Last Name:SCHULKEN
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 1:6549 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1175
Mailing Address - Country:US
Mailing Address - Phone:910-822-9610
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7394
Practice Address - Country:US
Practice Address - Phone:910-907-7538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP3807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist