Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A1941 | MN |
NPI | 1013423474 |
---|---|
Provider Name | Amy Jenson |
First Address | Park Rapids, MN 56470-1301 |
Second Address | Park Rapids, MN 56470-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 21/12/2017 |