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Individual

JACKY BRENTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
3676 PARKER BLVD STE 310, PUEBLO, CO 81008-2214
(719) 595-7780
Mailing address
PO BOX 8066, PUEBLO, CO 81008
(719) 289-5809

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0001926
CO

Other

Enumeration date
09/18/2020
Last updated
09/18/2020
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