Provider Demographics
NPI:1053435875
Name:PENKUNAS, LYNNE MARIE (PTA)
Entity type:Individual
Prefix:MISS
First Name:LYNNE
Middle Name:MARIE
Last Name:PENKUNAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 HAWKS LANDING LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-4035
Mailing Address - Country:US
Mailing Address - Phone:301-648-6066
Mailing Address - Fax:
Practice Address - Street 1:2720 CHARLES TOWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5626
Practice Address - Country:US
Practice Address - Phone:304-263-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00001155225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant