Provider Demographics
NPI:1043641640
Name:JENSEN, JAY B (PT, ATC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14925 SW BARROWS ROAD, STE 109, BOX 151
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007
Mailing Address - Country:US
Mailing Address - Phone:503-481-2973
Mailing Address - Fax:503-590-3687
Practice Address - Street 1:1849 SW SALMON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1726
Practice Address - Country:US
Practice Address - Phone:503-272-8785
Practice Address - Fax:503-590-3687
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist