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General NPI Number Information
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NPI Number | 1417045444
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Entity Type | Individual
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Provider Name | DANIEL PENA ATC, LPTA
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 4501 BIGGS AVENUE BLDG 939
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-1908
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Country | US
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Telephone | 505-846-7377
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Fax |
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Provider Business Mailing Address
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Address Line | 7413 LUELLA ANNE DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3935
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Country | US
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Telephone | 505-872-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-287
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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