Provider Demographics
NPI:1922844240
Name:JENSEN, JOSHUA DREW (PT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DREW
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-0306
Mailing Address - Country:US
Mailing Address - Phone:208-785-8018
Mailing Address - Fax:208-785-3332
Practice Address - Street 1:1250 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-5095
Practice Address - Country:US
Practice Address - Phone:208-785-8018
Practice Address - Fax:208-785-3332
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist