MEDICARE: JENNIFER HOLLY PADILLA

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	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1962672998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HOLLY PADILLA

Provider Business Mailing Address
First Line	:	2246 DEVON ST
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-5575
Country	:	US
Telephone Number	:	970-729-1287
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 W NORTH 1ST ST
Second Line	:
City	:	MONTROSE
State	:	CO
Zip	:	81401-3302
Country	:	US
Telephone Number	:	970-729-1287
Fax Number	:

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

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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Directions to “ JENNIFER HOLLY PADILLA ” Practice Location

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