Provider Demographics
NPI:1306997101
Name:JENSEN, TANYA LYNN (MPT)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYNN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAGO CV
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-3780
Mailing Address - Country:US
Mailing Address - Phone:832-265-7562
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2649
Practice Address - Country:US
Practice Address - Phone:281-480-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11344682251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics