Provider Demographics
NPI:1164794855
Name:JENSEN, TIFFANY PAIGE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:PAIGE
Last Name:JENSEN
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 1:5140 W. 120TH AVE.
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3307
Mailing Address - Country:US
Mailing Address - Phone:303-451-6706
Mailing Address - Fax:
Practice Address - Street 1:5140 W 120TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3307
Practice Address - Country:US
Practice Address - Phone:303-451-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist