Provider Demographics
NPI:1962672998
Name:PADILLA, JENNIFER HOLLY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOLLY
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 DEVON ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5575
Mailing Address - Country:US
Mailing Address - Phone:970-729-1287
Mailing Address - Fax:
Practice Address - Street 1:206 W NORTH 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3302
Practice Address - Country:US
Practice Address - Phone:970-729-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist