Provider Demographics
NPI:1770891038
Name:JENSON, ERIN (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:GRINSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:111 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-8239
Mailing Address - Country:US
Mailing Address - Phone:270-563-2084
Mailing Address - Fax:270-563-2085
Practice Address - Street 1:111 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171-8239
Practice Address - Country:US
Practice Address - Phone:270-563-2084
Practice Address - Fax:270-563-2085
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28620225100000X
KY005655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000678814OtherANTHEM
KY7100140460Medicaid
KY000000678814OtherANTHEM