Individual
RUSSELL J JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
720 FAIRGROUND AVE, HIGGINSVILLE, MO 64037-1638
(660) 584-7801
(660) 584-8619
Mailing address
720 FAIRGROUND AVE, HIGGINSVILLE, MO 64037-1638
(660) 584-7801
(660) 584-8619
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
117234
MO
Other
Enumeration date
05/31/2012
Last updated
09/07/2012
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