Provider Demographics
NPI:1316967292
Name:JENSEN-VICK, KAREN LYNN (DPT, COMT)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNN
Last Name:JENSEN-VICK
Suffix:
Gender:F
Credentials:DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CALLE TECATE STE 117
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5285
Mailing Address - Country:US
Mailing Address - Phone:805-383-0470
Mailing Address - Fax:805-856-1582
Practice Address - Street 1:4000 CALLE TECATE STE 117
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5285
Practice Address - Country:US
Practice Address - Phone:805-383-0470
Practice Address - Fax:805-856-1582
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015705C95Medicare ID - Type Unspecified