Provider Demographics
NPI:1609658582
Name:JENSEN, NAJAT ANTONIETTA (LMT, MLD-C)
Entity Type:Individual
Prefix:
First Name:NAJAT
Middle Name:ANTONIETTA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3092 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2558
Mailing Address - Country:US
Mailing Address - Phone:770-314-7704
Mailing Address - Fax:
Practice Address - Street 1:3092 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2558
Practice Address - Country:US
Practice Address - Phone:770-314-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT009017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist