Healthcare Provider Details

I. General information

NPI: 1073271607
Provider Name (Legal Business Name): JENSEN A CROMER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 N 26TH ST STE 100
LINCOLN NE
68521-4739
US

IV. Provider business mailing address

4911 N 26TH ST STE 100
LINCOLN NE
68521-4739
US

V. Phone/Fax

Practice location:
  • Phone: 402-477-3110
  • Fax:
Mailing address:
  • Phone: 402-477-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4306
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: