Provider Demographics
NPI:1790882223
Name:JENSEN & JENSEN THERAPY P. L. L. C
Entity Type:Organization
Organization Name:JENSEN & JENSEN THERAPY P. L. L. C
Other - Org Name:DRY CREEK PHYSICAL THERAPY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:801-766-4244
Mailing Address - Street 1:675 E 100 N
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1464
Mailing Address - Country:US
Mailing Address - Phone:801-763-5538
Mailing Address - Fax:801-766-4245
Practice Address - Street 1:3300 RUNNING CREEK WAY STE 150 BLDG B
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5673
Practice Address - Country:US
Practice Address - Phone:801-766-4244
Practice Address - Fax:801-766-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110083-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528806842001Medicaid
UT528806842001Medicaid