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General NPI Number Information
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NPI Number | 1588054167
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Entity Type | Individual
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Provider Name | BRENDA LEE JENSEN PTA
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 801 SE PARK CREST AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-1300
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Country | US
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Telephone | 360-852-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE STE D
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone | 360-852-2637
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1 60031661
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License Number State | WA
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