Provider Demographics
NPI:1942234513
Name:JENSEN, RICHARD ROY (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROY
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3383 LOST CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-9216
Mailing Address - Country:US
Mailing Address - Phone:406-560-6818
Mailing Address - Fax:406-563-4487
Practice Address - Street 1:3383 LOST CREEK RD
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711
Practice Address - Country:US
Practice Address - Phone:406-560-6818
Practice Address - Fax:406-563-4487
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347361Medicaid
MT060478OtherBCBS
MT060478OtherBCBS
MT0347361Medicaid