Individual
JAMES LEE PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5700 WILKIE DR, FORT WAYNE, IN 46804-1662
(260) 432-7556
Mailing address
1646 RICHARDSON ST, FORT WAYNE, IN 46808-3473
(260) 399-4880
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003741A
IN
225200000X
Physical Therapy Assistant
2076106
TX
225200000X
Physical Therapy Assistant
4793
TN
Other
Enumeration date
06/23/2010
Last updated
06/23/2010
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