Healthcare Provider Details

I. General information

NPI: 1821227778
Provider Name (Legal Business Name): JENSEN PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 JENSEN BEACH BLVD.
JENSEN BEACH FL
34957
US

IV. Provider business mailing address

702 JENSEN BEACH BLVD
JENSEN BEACH FL
34957
US

V. Phone/Fax

Practice location:
  • Phone: 772-225-8908
  • Fax: 772-225-0843
Mailing address:
  • Phone: 772-225-8908
  • Fax: 772-225-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLENN CRAIG SAMPSON
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: PT
Phone: 772-225-8908