Active NPI
Donald Penny
- Recreational Therapist Assistant
- Fernandina Beach, FL
National Provider Identifier
1861941643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreational Therapist Assistant
- License
- PTA26290
- Practice address
- 85072 Crews Rd
Fernandina Beach, FL 32034-1556 - Phone
- (904) 574-7477
- NPI assigned
- Sep 22, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A-1222 | NM | |
| Recreational Therapist Assistant | 226000000X | PTA26290 | FL | Primary |
Addresses
Primary practice location
85072 Crews Rd
Fernandina Beach, FL 32034-1556
Mailing address
85072 Crews Rd
Fernandina Beach, FL 32034-1556
Phone (904) 574-7477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-1222 | NM | MD | Physical Therapy Assistant |
| PTA26290 | FL | MD | Recreational Therapist Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474502400000",
"number": "1861941643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "85072 CREWS RD",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320341556",
"telephone_number": "904-574-7477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "85072 CREWS RD",
"city": "FERNANDINA BEACH",
"state": "FL",
"postal_code": "320341556",
"telephone_number": "904-574-7477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNY",
"first_name": "DONALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-22",
"last_updated": "2016-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NM",
"license": "A-1222",
"primary": false
},
{
"code": "226000000X",
"taxonomy_group": "",
"desc": "Recreational Therapist Assistant",
"state": "FL",
"license": "PTA26290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fernandina Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.