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1306284062 NPI number — TYLER JUSTIN JENSEN DPT

NPI Number: 1306284062
Health Care Provider/Practitioner: TYLER JUSTIN JENSEN DPT

Information about “1306284062” NPI (TYLER JUSTIN JENSEN DPT) exists in 1306284062 in HTML format HTML  |  1306284062 in plain Text format TXT  |  1306284062 in PDF (Portable Document Format) PDF  |  1306284062 in an XML format XML  formats.

NPI Number : 1306284062 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306284062",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JENSEN",
    "FirstName": "TYLER",
    "MiddleName": "JUSTIN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SERVICE",
    "OtherFirstName": "TYLER",
    "OtherMiddleName": "JUSTIN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "129 WALKER HILL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CROSSVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38555-5484",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-787-1715",
    "MailingAddressFaxNumber": "931-218-6996",
    "FirstLinePracticeLocationAddress": "129 WALKER HILL ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CROSSVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38555-5484",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "931-787-1715",
    "PracticeLocationAddressFaxNumber": "931-218-6996",
    "EnumerationDate": "06/04/2013",
    "LastUpdateDate": "06/04/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "8515460-2401",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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