Healthcare Provider Details

I. General information

NPI: 1275034431
Provider Name (Legal Business Name): JACOB LAMARCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5184 S BROADWAY
ENGLEWOOD CO
80113-6706
US

IV. Provider business mailing address

5012 S 94TH AVE
OMAHA NE
68127-2410
US

V. Phone/Fax

Practice location:
  • Phone: 720-372-0865
  • Fax: 720-386-3392
Mailing address:
  • Phone: 402-616-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberNO
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020266
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: