Provider Demographics
NPI:1285315507
Name:DANIEL, JENSON JOSE (PTA)
Entity type:Individual
Prefix:
First Name:JENSON
Middle Name:JOSE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 RIVERSIDE PARK RD APT 2
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5371
Mailing Address - Country:US
Mailing Address - Phone:914-510-5861
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST S
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4499
Practice Address - Country:US
Practice Address - Phone:914-510-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant