MEDICARE: JENNIFER TANNER HENRIKSEN 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	PT60277353	WA
2	225100000X	Physical Therapist	5020	OR
3	225100000X	Physical Therapist	297376	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0302887	OTHER	WA	DEPT. OF LABOR AND INDUSTRIES

General Provider Information

NPI Number	:	1942235726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TANNER HENRIKSEN MSPT

Provider Business Mailing Address
First Line	:	6785 N WILLOW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5900
Country	:	US
Telephone Number	:	559-257-3991
Fax Number	:	559-257-3992

Provider Business Practice Location Address
First Line	:	6785 N WILLOW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-5900
Country	:	US
Telephone Number	:	559-257-3991
Fax Number	:	559-257-3992

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/02/2026

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Directions to “ JENNIFER TANNER HENRIKSEN MSPT” Practice Location

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