Provider Demographics
NPI:1942428552
Name:JENSEN, LEANN KAY (PT)
Entity Type:Individual
Prefix:MS
First Name:LEANN
Middle Name:KAY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 CALIFORNIA CONDOR WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6609
Mailing Address - Country:US
Mailing Address - Phone:415-883-4662
Mailing Address - Fax:415-897-5771
Practice Address - Street 1:351 SAN ANDREAS DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1206
Practice Address - Country:US
Practice Address - Phone:415-898-5772
Practice Address - Fax:415-897-4771
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist