MEDICARE: JENSON RICHARD GIAMMATTEO DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1104478221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENSON RICHARD GIAMMATTEO DPT

Provider Business Mailing Address
First Line	:	314 S MANNING BLVD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-1708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 S PEARL ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12202-1013
Country	:	US
Telephone Number	:	518-427-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	05/13/2026

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