# JENSEN INTERHEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PT Connections
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316978893
- **Authorized official:** MICHELLE MARIE GRACE-JENSEN PT (VICE-PRESIDENT)
- **Authorized official phone:** (920) 994-4515

## Contact information

- **Practice address:** 233 CARROLL ST, RANDOM LAKE, WI 53075
- **Practice address phone:** (920) 994-4515
- **Practice address fax:** (920) 994-4583
- **Mailing address:** W8093 COUNTY A, ADELL, WI 53001-1462
- **Mailing address phone:** (920) 994-4515
- **Mailing address fax:** (920) 994-4583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 3728-24 | WI | Yes |

## Other

- **Enumeration date:** 07/05/2006
- **Last updated:** 08/13/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3728-024 | LISCENSE | WI |
| 05 | — | 40428700 | — | WI |