MEDICARE: MRS. JENNIFER P PEJO MS, ATC, NCTM

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	225700000X	Massage Therapist	18263	CO

General Provider Information

NPI Number	:	1881843969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER P PEJO MS, ATC, NCTM

Provider Business Mailing Address
First Line	:	12644 PINE VALLEY CIR
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-4019
Country	:	US
Telephone Number	:	719-271-7379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 ACADEMY PL
Second Line	:	SUITE 205 B
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1680
Country	:	US
Telephone Number	:	719-271-7379
Fax Number	:

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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