Healthcare Provider Details

I. General information

NPI: 1629609045
Provider Name (Legal Business Name): SABRE JEAN MENNINGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date: 02/04/2020
Reactivation Date: 11/01/2024

III. Provider practice location address

600 I ST
PAWNEE CITY NE
68420-3001
US

IV. Provider business mailing address

61299 705TH RD
BURCHARD NE
68323-4039
US

V. Phone/Fax

Practice location:
  • Phone: 402-852-2231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP056297T
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07747
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: