Provider Demographics
NPI:1447659651
Name:HOMAN-MUISE, PENNY
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HOMAN-MUISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5741
Mailing Address - Country:US
Mailing Address - Phone:562-477-5144
Mailing Address - Fax:
Practice Address - Street 1:609 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5741
Practice Address - Country:US
Practice Address - Phone:562-477-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist