Individual
NICHOLAS PENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1005 LUJAN HILL RD, LAS CRUCES, NM 88007-6304
(575) 523-4573
Mailing address
5031 WESTFIELD DR NE, RIO RANCHO, NM 87144-6564
(661) 547-6380
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1599
NM
225200000X
Physical Therapy Assistant
—
NM
225200000X
Physical Therapy Assistant
—
—
Other
Enumeration date
01/13/2023
Last updated
02/02/2023
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