Provider Demographics
NPI:1750406856
Name:SARGENT, JENNIFER ESTHER (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ESTHER
Last Name:SARGENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ESTHER
Other - Last Name:ELHOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4638 VICTOR PATH
Mailing Address - Street 2:100
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4733
Mailing Address - Country:US
Mailing Address - Phone:651-407-3777
Mailing Address - Fax:651-407-7064
Practice Address - Street 1:4638 VICTOR PATH
Practice Address - Street 2:100
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-4733
Practice Address - Country:US
Practice Address - Phone:651-407-3777
Practice Address - Fax:651-407-7064
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49222251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist