Healthcare Provider Details

I. General information

NPI: 1346134632
Provider Name (Legal Business Name): JORRE LUTHER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5336
US

IV. Provider business mailing address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5336
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-0404
  • Fax:
Mailing address:
  • Phone: 402-496-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4783
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: