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NPI Code Detail

MEDICARE: INEZ MARIE JENSEN PTA

MEDICARE: INEZ MARIE JENSEN PTA
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
1225200000XPhysical Therapy Assistant2000145052MO

General Provider Information

NPI Number : 1407125214
Entity Type Code : Individual
Provider Name (Legal Business Name) : INEZ MARIE JENSEN PTA
Provider Business Mailing Address
First Line : PO BOX 383
Second Line :
City : WARSAW
State : MO
Zip : 65355-0383
Country : US
Telephone Number : 800-385-3978
Fax Number : 660-438-6943
Provider Business Practice Location Address
First Line : 620 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1926
Country : US
Telephone Number : 573-265-3271
Fax Number : 573-265-5234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2011
Last Update Date : 12/22/2011

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