Individual
MS. SUSAN ELIZABETH PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2001 LANES MILL RD, BRICK, NJ 08724-1405
(732) 785-3090
(732) 836-1251
Mailing address
412 ROSE AVE, BRICK, NJ 08724-2108
(732) 458-0367
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00058400
NJ
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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