Provider Demographics
NPI:1619617552
Name:JENSON, ANDREA (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 PUDDLEDOCK RD
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:WI
Mailing Address - Zip Code:53504-9721
Mailing Address - Country:US
Mailing Address - Phone:608-774-1890
Mailing Address - Fax:
Practice Address - Street 1:719 E CATHERINE ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1330
Practice Address - Country:US
Practice Address - Phone:608-774-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant