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General NPI Number Information
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NPI Number | 1275034431
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Entity Type | Individual
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Provider Name | JACOB LAMARCHE
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Gender | Male
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 5184 S BROADWAY
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City | ENGLEWOOD
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State | CO
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Zip | 80113-6706
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Country | US
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Telephone | 720-372-0865
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Fax | 720-386-3392
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Provider Business Mailing Address
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Address Line | 5012 S 94TH AVE
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City | OMAHA
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State | NE
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Zip | 68127-2410
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Country | US
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Telephone | 402-616-9306
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | NO
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0020266
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License Number State | CO
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