Provider Demographics
NPI:1457444259
Name:JENSEN, DEBORA J (BSPT)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:J
Last Name:JENSEN
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:JOANIE
Other - Middle Name:JOAN
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSPT
Mailing Address - Street 1:6703 W RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2623
Mailing Address - Country:US
Mailing Address - Phone:509-946-6144
Mailing Address - Fax:509-783-5438
Practice Address - Street 1:965 GOETHALS
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7623
Practice Address - Country:US
Practice Address - Phone:509-946-6144
Practice Address - Fax:509-943-9521
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002034225100000X
WAPT00010693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8426710Medicaid
WA0197166OtherDEPT. OF LABOR & INDUSTRI
0197166OtherLABOR & INDUSTRIES
WA8426710Medicaid