Basic Information
| Provider Information | |||||||||
| NPI: | 1548412489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENSEN | ||||||||
| FirstName: | JO ANN | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 ASCOT DR | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760925118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173103401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5215 N O'CONNOR BLVD. | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694209500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 2052623 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.