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General NPI Number Information
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NPI Number | 1679925986
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Entity Type | Individual
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Provider Name | KATHLEEN ANN JENSEN
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Gender | Female
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Dates
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Enumeration Date | 07/11/2016
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 5969 N CANTON CENTER RD
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City | CANTON
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State | MI
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Zip | 48187-2757
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Country | US
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Telephone | 877-407-3422
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Fax | 877-407-4329
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Provider Business Mailing Address
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Address Line | 209 S CHERRY ST
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City | FLUSHING
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State | MI
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Zip | 48433-2020
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Country | US
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Telephone | 810-487-9733
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Fax | 810-867-4938
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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 | 5502003562
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501302335
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License Number State | MI
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