Provider Demographics
NPI:1255618690
Name:DUJKA, TRENA SUE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:TRENA
Middle Name:SUE
Last Name:DUJKA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-0912
Mailing Address - Country:US
Mailing Address - Phone:970-625-6555
Mailing Address - Fax:
Practice Address - Street 1:201 SIPPRELLE DR
Practice Address - Street 2:
Practice Address - City:PARACHUTE
Practice Address - State:CO
Practice Address - Zip Code:81635-9234
Practice Address - Country:US
Practice Address - Phone:970-285-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7656225100000X
COPTL.0007656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist