Provider Demographics
NPI:1437289659
Name:JENSSEN, JACOB R (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:R
Last Name:JENSSEN
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SCHOOL ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1337
Mailing Address - Country:US
Mailing Address - Phone:763-400-7438
Mailing Address - Fax:
Practice Address - Street 1:1000 SCHOOL ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1337
Practice Address - Country:US
Practice Address - Phone:763-400-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37056225100000X
MN0207026912255A2300X
MN8555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer