Individual
DERRICK CHRISTOPHER PENTICUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4115 CLUB MANOR DR, PUEBLO, CO 81008
(968) 568-9790
Mailing address
4115 CLUB MANOR DR., PUEBLO, CO 81008
(417) 709-5228
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/01/2020
Last updated
04/12/2023
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