Healthcare Provider Details

I. General information

NPI: 1912502972
Provider Name (Legal Business Name): KRISTIN MARIE JENSEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 TILGHMAN DR STE 200
DUNN NC
28334-6066
US

IV. Provider business mailing address

5335 S VALENTIA WAY APT 440
GREENWOOD VILLAGE CO
80111-3128
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-5635
  • Fax:
Mailing address:
  • Phone: 719-722-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014905
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: