Provider Demographics
NPI:1215326798
Name:JENSEN, JENNIFER GAY (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GAY
Last Name:JENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SUMMIT ST
Mailing Address - Street 2:LEBANON
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1943
Mailing Address - Country:US
Mailing Address - Phone:513-476-8350
Mailing Address - Fax:
Practice Address - Street 1:446 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-2241
Practice Address - Country:US
Practice Address - Phone:937-985-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist