Provider Demographics
NPI:1770818296
Name:PENA, GEORGE ANTHONY (RMT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:PENA
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RMT
Mailing Address - Street 1:333 W HAMPDEN AVE STE 420E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2334
Mailing Address - Country:US
Mailing Address - Phone:303-931-2133
Mailing Address - Fax:303-781-1022
Practice Address - Street 1:333 W HAMPDEN AVE
Practice Address - Street 2:SUITE 420E
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2330
Practice Address - Country:US
Practice Address - Phone:303-931-2133
Practice Address - Fax:303-781-1022
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4899225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4899OtherDEPARTMENT OF REGULATORY AGENCIES