Provider Demographics
NPI:1669441184
Name:JENSEN, MICHAEL JOHN (MPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:FRONTIER
Other - Middle Name:PHYSICAL
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:115 SMELTER AVE NE, SUITE 104
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404
Mailing Address - Country:US
Mailing Address - Phone:406-727-2826
Mailing Address - Fax:406-727-3522
Practice Address - Street 1:115 SMELTER AVE NE, SUITE 104
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404
Practice Address - Country:US
Practice Address - Phone:406-727-2826
Practice Address - Fax:406-727-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0340812Medicaid
MT60963OtherBCBS
MT0340812Medicaid