Individual
KATHLEEN PENNOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PT
Contact information
Practice address
10128 W BROAD ST BLDG III, GLEN ALLEN, VA 23060-6761
(804) 217-9210
(804) 217-9213
Mailing address
10128 W BROAD ST BLDG III, GLEN ALLEN, VA 23060-6761
(804) 217-9210
(804) 217-9213
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305202695
VA
2251X0800X
Orthopedic Physical Therapist
2305202695
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010206626
—
VA
01
—
192289
ANTHEM HANOVER PT
VA
01
—
258462
SOUTHERN HEALTH
VA
01
—
540885859
PRIVATE HEALTHCARE SYSTEM
VA
01
—
98999
OPTIMA HEALTH
VA
Enumeration date
06/04/2006
Last updated
01/09/2025
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