Provider Demographics
NPI:1871110510
Name:JENSEN, DILLON (PTA)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68743-3046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 W 25TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-1705
Practice Address - Country:US
Practice Address - Phone:712-252-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty