Healthcare Provider Details

I. General information

NPI: 1528890712
Provider Name (Legal Business Name): LANDON WILLIS JENSEN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 W 4700 S
WEST VALLEY CITY UT
84129-3454
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 801-840-2191
  • Fax: 801-840-2197
Mailing address:
  • Phone: 801-510-0216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14001437-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: