Provider Demographics
NPI:1184931800
Name:JENSEN, DAVID R (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
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 1:7201 W CLEARWATER AVE
Mailing Address - Street 2:SUITE B101
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1694
Mailing Address - Country:US
Mailing Address - Phone:509-544-0265
Mailing Address - Fax:509-987-1614
Practice Address - Street 1:7201 W CLEARWATER AVE
Practice Address - Street 2:SUITE B101
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1694
Practice Address - Country:US
Practice Address - Phone:509-544-0265
Practice Address - Fax:509-987-1614
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60159869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist