Individual
STACEY L PENVOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
75 EVELYN DR, MILLERSBURG, PA 17061-1258
(717) 692-4708
Mailing address
75 EVELYN DR, MILLERSBURG, PA 17061-1258
(717) 692-4708
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RTO000041
PA
Other
Enumeration date
01/28/2008
Last updated
01/28/2008
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