Provider Demographics
NPI:1699964833
Name:ALVAREZ, PENNY LORENE (LMT LICENSED MASSAGE)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:LORENE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMT LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N CENTRAL AVE
Mailing Address - Street 2:STE LL03
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-274-1412
Mailing Address - Fax:
Practice Address - Street 1:3550 N CENTRAL AVE
Practice Address - Street 2:STE LL03
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-274-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT01038P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist