Provider Demographics
NPI:1700577947
Name:JENSEN, AUSTIN (PTA, LMT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PTA, LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11508 11TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2501
Mailing Address - Country:US
Mailing Address - Phone:941-779-7539
Mailing Address - Fax:
Practice Address - Street 1:2601 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4942
Practice Address - Country:US
Practice Address - Phone:941-779-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26159225200000X
FLMA71263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant