Provider Demographics
NPI:1902341712
Name:JENSEN, JACOB (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N COLLEGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5822
Mailing Address - Country:US
Mailing Address - Phone:208-734-5313
Mailing Address - Fax:208-736-1582
Practice Address - Street 1:754 N COLLEGE RD STE D
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5822
Practice Address - Country:US
Practice Address - Phone:208-734-5313
Practice Address - Fax:208-736-1582
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT-5849OtherPT LICENSE
ID1902341712Medicaid
UT10626586-2401OtherPT LICENSE