MEDICARE: JACOB LAMARCHE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTL.0020266	CO
2	2255A2300X	Athletic Trainer	NO	NE

General Provider Information

NPI Number	:	1275034431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB LAMARCHE

Provider Business Mailing Address
First Line	:	5012 S 94TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-2410
Country	:	US
Telephone Number	:	402-616-9306
Fax Number	:

Provider Business Practice Location Address
First Line	:	5184 S BROADWAY
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80113-6706
Country	:	US
Telephone Number	:	720-372-0865
Fax Number	:	720-386-3392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	01/16/2026

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