Provider Demographics
NPI:1366646762
Name:JENSEN, CHARA LEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHARA
Middle Name:LEIGH
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2206
Mailing Address - Country:US
Mailing Address - Phone:417-234-0476
Mailing Address - Fax:
Practice Address - Street 1:331 HOSPITAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9217
Practice Address - Country:US
Practice Address - Phone:417-533-6315
Practice Address - Fax:417-533-6320
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist