1538494034 NPI number — MS. SHAREE JO FEJFAR-JEDLICKA PT, DPT

Table of content: MS. SHAREE JO FEJFAR-JEDLICKA PT, DPT (NPI 1538494034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538494034 NPI number — MS. SHAREE JO FEJFAR-JEDLICKA PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEJFAR-JEDLICKA
Provider First Name:
SHAREE
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FEJFAR
Provider Other First Name:
SHAREE
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538494034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3763 39TH AVE
Provider Second Line Business Mailing Address:
SUITE #100
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68601-4504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-615-0183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3763 39TH AVE
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-615-0183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1752 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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