Healthcare Provider Details

I. General information

NPI: 1184352668
Provider Name (Legal Business Name): JANNA M VAVRA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 S 86TH ST STE 100
LINCOLN NE
68526-9225
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 402-261-4739
  • Fax: 402-261-4972
Mailing address:
  • Phone: 402-477-3110
  • Fax: 402-477-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: