Provider Demographics
NPI:1184947004
Name:PENA SMITH, JENNIFER CRISTEN (LMT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CRISTEN
Last Name:PENA SMITH
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 1:201 HERMOSA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1023
Mailing Address - Country:US
Mailing Address - Phone:505-803-5353
Mailing Address - Fax:
Practice Address - Street 1:201 HERMOSA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1023
Practice Address - Country:US
Practice Address - Phone:505-803-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6541172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist