MEDICARE: MRS. DAWN MARIE JENSON MSPT

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	6046	CO

General Provider Information

NPI Number	:	1629492194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN MARIE JENSON MSPT

Provider Business Mailing Address
First Line	:	4744 WESTERN EVENING CT
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80109-2864
Country	:	US
Telephone Number	:	303-408-1720
Fax Number	:

Provider Business Practice Location Address
First Line	:	6325 S UNIVERSITY BLVD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2914
Country	:	US
Telephone Number	:	303-408-1720
Fax Number	:

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	09/17/2019

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