Provider Demographics
NPI:1073734836
Name:TREJO, JENNIFER LEIGH (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:TREJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 TASCO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2223
Mailing Address - Country:US
Mailing Address - Phone:505-321-8993
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVERVIEW DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-0920
Practice Address - Country:US
Practice Address - Phone:505-312-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NM3166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist