Healthcare Provider Details

I. General information

NPI: 1285170472
Provider Name (Legal Business Name): JEFFREY BRANDON JENSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MIDDLETOWN RD
FAIRMONT WV
26554-8176
US

IV. Provider business mailing address

610 WINDWOOD PL
MORGANTOWN WV
26505-2771
US

V. Phone/Fax

Practice location:
  • Phone: 304-534-8122
  • Fax: 304-534-8131
Mailing address:
  • Phone: 435-899-0405
  • Fax: 304-534-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004643
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: