Individual
PENNY TREVITHICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CBS
Contact information
Practice address
8380 HYGIENE RD, LONGMONT, CO 80503
(303) 579-7003
Mailing address
P.O. BOX 145, HYGIENE, CO 80533
(303) 579-7003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5095BF
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5095BC
NATIONAL THERAPIES CERTICICATION BOARD
—
Enumeration date
12/23/2009
Last updated
12/23/2009
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