Healthcare Provider Details

I. General information

NPI: 1992629612
Provider Name (Legal Business Name): JAYSON HENRICKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20117 FRANKLIN CIR # 100
ELKHORN NE
68022-6578
US

IV. Provider business mailing address

7327 N 166TH ST
BENNINGTON NE
68007-2833
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-2026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5003
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: