Provider Demographics
NPI:1528404811
Name:JENSON, TAMMY RAE (LMP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RAE
Last Name:JENSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 W CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7906
Mailing Address - Country:US
Mailing Address - Phone:509-727-2967
Mailing Address - Fax:
Practice Address - Street 1:1950 KEENE RD
Practice Address - Street 2:BLDG J
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7751
Practice Address - Country:US
Practice Address - Phone:509-727-2967
Practice Address - Fax:509-769-5220
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60368169172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist