Provider Demographics
NPI:1528890712
Name:JENSEN, LANDON WILLIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:WILLIS
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E ROWLEY DR
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3026
Mailing Address - Country:US
Mailing Address - Phone:801-510-0216
Mailing Address - Fax:
Practice Address - Street 1:5151 S 900 E STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-6658
Practice Address - Country:US
Practice Address - Phone:801-261-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14001437-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist