Provider Demographics
NPI:1114305513
Name:FLORES, JENNA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 W COAL MINE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-4401
Mailing Address - Country:US
Mailing Address - Phone:303-979-0342
Mailing Address - Fax:303-979-3872
Practice Address - Street 1:8370 W COAL MINE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-4401
Practice Address - Country:US
Practice Address - Phone:303-979-0342
Practice Address - Fax:303-979-3872
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist