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Individual
MRS. TRICIA MARIE CARR PENY
Active
Individual
MRS. TRICIA MARIE CARR PENY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305004725
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
187835
BLUE CROSS BLUE SHIELD
VA
01
—
300416
AMERIGROUP
VA
Enumeration date
01/05/2007
Last updated
07/08/2007
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