Provider Demographics
NPI:1043589872
Name:PENDAS, JUDY MARION (RCMT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MARION
Last Name:PENDAS
Suffix:
Gender:F
Credentials:RCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4148
Mailing Address - Country:US
Mailing Address - Phone:970-618-7825
Mailing Address - Fax:
Practice Address - Street 1:812 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3342
Practice Address - Country:US
Practice Address - Phone:970-618-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist