Holly Pennington, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00008860 Issued in WA

Practice address

8910 184TH Ave E
Bonney Lake, WA 98391-8531

Phone

(253) 863-7510

Fax

(253) 863-5970

NPI assigned

Aug 18, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Holly Brooks Former name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Outpatient Physical Therapy & Sports Rehabilitation Inc PC

  • Physical Therapist
  • Maple Valley, WA
  • NPI 1730394420
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1346232022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26837 MAPLE VALLEY BLACK DIAMOND RD SE",
            "address_2": "STE 200",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980389917",
            "telephone_number": "425-413-4427",
            "fax_number": "425-413-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8910 184TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918531",
            "telephone_number": "253-863-7510",
            "fax_number": "253-863-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "HOLLY",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8333379",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "BROOKS",
            "prefix": "MISS",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cheyenne Passmore
• Bijal Patel, M.D.
• Kaitlyn Jeanne Patrick
• Abigayle Marion Patterson, APRN
• Sandra Lee Pearson, REGISTERED NURSE
• Performance Sports and Spine Physical Therapy PS
• Brandon Edward Perkes, DC
• Alexandrea Lee Pettyjohn, LMP
• Mary Ellen Pfeiffer, B.A., L.M.P.
• Crystal Gayle Phillips, COTA/L

• Physical Therapist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.