Provider Demographics
NPI:1285170472
Name:JENSON, JEFFREY BRANDON (DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRANDON
Last Name:JENSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WINDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2771
Mailing Address - Country:US
Mailing Address - Phone:435-899-0405
Mailing Address - Fax:304-534-8131
Practice Address - Street 1:51 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8176
Practice Address - Country:US
Practice Address - Phone:304-534-8122
Practice Address - Fax:304-534-8131
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 172V00000X
WV004643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker