Healthcare Provider Details

I. General information

NPI: 1376576934
Provider Name (Legal Business Name): EMILY LYNN JENSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PATTERSON AVE SUITE 8
SHREWSBURY NJ
07702-4176
US

IV. Provider business mailing address

570 CEDAR AVE
WEST LONG BRANCH NJ
07764-1757
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6600
  • Fax: 732-842-6606
Mailing address:
  • Phone: 732-915-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number23734
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number40QA01206900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: