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General NPI Number Information
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NPI Number | 1871314591
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Entity Type | Organization
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Legal Business Name | TREVOR JENSEN
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 4607 PONTIAC TRL
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City | ANN ARBOR
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State | MI
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Zip | 48105-9365
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Country | US
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Telephone | 734-985-0705
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Fax | 734-256-4089
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Provider Business Mailing Address
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Address Line | 4607 PONTIAC TRL
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City | ANN ARBOR
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State | MI
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Zip | 48105-9365
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Country | US
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Telephone | 734-985-0705
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Fax | 734-256-4089
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | TREVOR JENSEN
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Credential |
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Telephone | 734-985-0705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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