Individual
MIRANDA JENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 MESQUITE RD, SOUTHLAKE, TX 76092-5865
(817) 707-0021
Mailing address
1715 MESQUITE RD, SOUTHLAKE, TX 76092-5865
(817) 707-0021
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1470
SC
Other
Enumeration date
06/28/2015
Last updated
06/28/2015
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