Provider Demographics
NPI:1033947890
Name:JENS, CODY AUSTIN (CMT)
Entity type:Individual
Prefix:MR
First Name:CODY
Middle Name:AUSTIN
Last Name:JENS
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 HILLTOP WAY
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93225-9577
Mailing Address - Country:US
Mailing Address - Phone:818-309-5016
Mailing Address - Fax:
Practice Address - Street 1:1832 HILLTOP WAY
Practice Address - Street 2:
Practice Address - City:FRAZIER PARK
Practice Address - State:CA
Practice Address - Zip Code:93225-9577
Practice Address - Country:US
Practice Address - Phone:818-309-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist