Provider Demographics
NPI:1528477239
Name:PENNUTO, ANTHONY (MS LAT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PENNUTO
Suffix:
Gender:M
Credentials:MS LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 10TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1353
Mailing Address - Country:US
Mailing Address - Phone:312-802-9623
Mailing Address - Fax:
Practice Address - Street 1:2701 PRAIRIE MEADOW DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-8001
Practice Address - Country:US
Practice Address - Phone:319-467-8317
Practice Address - Fax:319-467-8247
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0930302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer