Healthcare Provider Details

I. General information

NPI: 1710186044
Provider Name (Legal Business Name): SUE JEFFREY PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 N COTNER BLVD SUITE 125
LINCOLN NE
68505-2310
US

IV. Provider business mailing address

770 N COTNER BLVD SUITE 125
LINCOLN NE
68505-2310
US

V. Phone/Fax

Practice location:
  • Phone: 402-464-6141
  • Fax: 402-464-6142
Mailing address:
  • Phone: 402-464-6141
  • Fax: 402-464-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number245
License Number StateNE

VIII. Authorized Official

Name: SUE K JEFFREY
Title or Position: PRESIDENT
Credential: PT
Phone: 402-464-6141