Provider Demographics
NPI:1730488198
Name:JENSEN, GENA RIGG (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:RIGG
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 OAK BLFS
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-7539
Mailing Address - Country:US
Mailing Address - Phone:919-929-2505
Mailing Address - Fax:
Practice Address - Street 1:494 OAK BLFS
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-7539
Practice Address - Country:US
Practice Address - Phone:919-929-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT 9895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC250188Medicare PIN