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Organization
JENSEN INTERHEALTH
Active
Organization
JENSEN INTERHEALTH
Active
Other names
PT Connections
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MARIE GRACE-JENSEN PT (VICE-PRESIDENT)
(920) 994-4515
Entity
Organization
Contact information
Practice address
233 CARROLL ST, RANDOM LAKE, WI 53075
(920) 994-4515
(920) 994-4583
Mailing address
W8093 COUNTY A, ADELL, WI 53001-1462
(920) 994-4515
(920) 994-4583
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3728-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3728-024
LISCENSE
WI
05
—
40428700
—
WI
Enumeration date
07/05/2006
Last updated
08/13/2007
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