MEDICARE: DANIEL KENT JENSEN 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	PT023896	PA

General Provider Information

NPI Number	:	1922417310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL KENT JENSEN DPT

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	2950 SAINT LAWRENCE AVE
Second Line	:
City	:	READING
State	:	PA
Zip	:	19606-2233
Country	:	US
Telephone Number	:	484-577-4549
Fax Number	:	484-577-4820

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	05/27/2020

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