Individual
MS. NANCY THERESA MCDONNELL-PENROSE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
180 W 1ST ST #101, KETCHUM, ID 83340
(208) 725-5185
(208) 725-5192
Mailing address
PO BOX 2182, 180 W 1ST ST #101, KETCHUM, ID 83340-2182
(208) 725-5185
(208) 725-5192
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT222
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TS832
BLUE CROSS
ID
Enumeration date
01/04/2006
Last updated
07/08/2007
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