Provider Demographics
NPI:1942897384
Name:CHRISTENSEN, JARED (DPT)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:JARED
Other - Middle Name:ANTHONY
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:1055 N 300 W STE 410
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3354
Mailing Address - Country:US
Mailing Address - Phone:801-616-3675
Mailing Address - Fax:877-510-5533
Practice Address - Street 1:1055 N 300 W STE 410
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3354
Practice Address - Country:US
Practice Address - Phone:801-616-3675
Practice Address - Fax:877-510-5533
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5553532-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist