MEDICARE: LANDON WILLIS JENSEN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14001437-2401	UT

General Provider Information

NPI Number	:	1528890712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANDON WILLIS JENSEN PT, DPT

Provider Business Mailing Address
First Line	:	727 E ROWLEY DR
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84107-3026
Country	:	US
Telephone Number	:	801-510-0216
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 S 900 E STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84117-6658
Country	:	US
Telephone Number	:	801-261-3321
Fax Number	:	801-261-5942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	04/07/2026

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