Provider Demographics
NPI:1326267345
Name:PENA, ANNETTE MARIE (CMT)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:MARIE
Last Name:PENA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2126
Mailing Address - Country:US
Mailing Address - Phone:720-937-1029
Mailing Address - Fax:
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 701
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:303-757-2455
Practice Address - Fax:303-757-2453
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONOT NEEDED225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist