Provider Demographics
NPI:1013452937
Name:RADLEY, JENSEN LYNN
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:LYNN
Last Name:RADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WHITNEY RANCH DR APT 3421
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3049
Mailing Address - Country:US
Mailing Address - Phone:775-420-6209
Mailing Address - Fax:
Practice Address - Street 1:1050 WHITNEY RANCH DR APT 3421
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3049
Practice Address - Country:US
Practice Address - Phone:775-420-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer