Provider Demographics
NPI:1154603496
Name:PENA, RITA SONIA (LMT)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:SONIA
Last Name:PENA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 RIO GRANDE LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77801-2821
Mailing Address - Country:US
Mailing Address - Phone:979-422-5428
Mailing Address - Fax:
Practice Address - Street 1:3001 WILDFLOWER DR
Practice Address - Street 2:SUITE 611
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3061
Practice Address - Country:US
Practice Address - Phone:979-774-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT037728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor