MEDICARE: JENNIFER F PENA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0016511	CO

General Provider Information

NPI Number	:	1801610522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER F PENA PT

Provider Business Mailing Address
First Line	:	3088 BLACKWOOD PL
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-1462
Country	:	US
Telephone Number	:	415-412-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	3088 BLACKWOOD PL
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80920-1462
Country	:	US
Telephone Number	:	415-412-1362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2024
Last Update Date	:	12/26/2024

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