Healthcare Provider Details

I. General information

NPI: 1518036375
Provider Name (Legal Business Name): DANIELLE LEA JENSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

2440 ANGLING RD
CORFU NY
14036-9690
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8940
  • Fax: 585-786-1275
Mailing address:
  • Phone: 585-762-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number014641
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: