Provider Demographics
NPI:1396203881
Name:CHRISTENSEN, JOSEPH LLOYD (DPT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LLOYD
Last Name:CHRISTENSEN
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 1:1454 SPRINGDELL CIR
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-9630
Mailing Address - Country:US
Mailing Address - Phone:801-602-8404
Mailing Address - Fax:
Practice Address - Street 1:37451 MAIN ST STE A&B
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4372
Practice Address - Country:US
Practice Address - Phone:530-335-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295939261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy