Provider Demographics
NPI:1659371110
Name:JENSEN, MELISSA L (PTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5799 BROADMOOR ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2403
Mailing Address - Country:US
Mailing Address - Phone:913-384-5600
Mailing Address - Fax:913-384-0719
Practice Address - Street 1:5799 BROADMOOR ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2403
Practice Address - Country:US
Practice Address - Phone:913-384-5600
Practice Address - Fax:913-384-0719
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-01654225200000X
MO2002019242225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant