Provider Demographics
NPI:1376576934
Name:JENSEN, EMILY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LYNN
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 1:570 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1757
Mailing Address - Country:US
Mailing Address - Phone:732-915-8600
Mailing Address - Fax:
Practice Address - Street 1:166 PATTERSON AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4176
Practice Address - Country:US
Practice Address - Phone:732-842-6600
Practice Address - Fax:732-842-6606
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237342251P0200X
NJ40QA012069002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics