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General NPI Number Information
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NPI Number | 1700577947
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Entity Type | Individual
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Provider Name | AUSTIN JENSEN PTA, LMT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 2601 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-4942
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Country | US
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Telephone | 941-779-7539
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Fax |
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Provider Business Mailing Address
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Address Line | 11508 11TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34212-2501
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Country | US
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Telephone | 941-779-7539
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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 | PTA26159
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA71263
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License Number State | FL
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