Provider Demographics
NPI:1477722528
Name:AMBROSIA-JENSEN, TERESA M (PT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:AMBROSIA-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 1:5100 ELDORADO PKWY # 102-20TR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:469-310-9170
Mailing Address - Fax:469-310-1701
Practice Address - Street 1:5855 MILTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206
Practice Address - Country:US
Practice Address - Phone:469-310-1700
Practice Address - Fax:469-310-1701
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1082998OtherLICENSE