Provider Demographics
NPI:1043351307
Name:PENFOLD, THOMAS (CPO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PENFOLD
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9698
Mailing Address - Country:US
Mailing Address - Phone:906-353-7161
Mailing Address - Fax:906-353-7000
Practice Address - Street 1:509 S SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9698
Practice Address - Country:US
Practice Address - Phone:906-353-7161
Practice Address - Fax:906-353-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist