Healthcare Provider Details

I. General information

NPI: 1962540054
Provider Name (Legal Business Name): STACY LYNN LERNER PT, PCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 10/03/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S NEBRASKA 8200 DODGE STREET
OMAHA NE
68114
US

IV. Provider business mailing address

1622 N 53RD ST
OMAHA NE
68104-4948
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3985
  • Fax:
Mailing address:
  • Phone: 312-498-8427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2751
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: