Provider Demographics
NPI:1043973431
Name:LARSEN, JAMIE MAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MAE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 COUNTY ROAD 13
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-4122
Mailing Address - Country:US
Mailing Address - Phone:402-277-0388
Mailing Address - Fax:
Practice Address - Street 1:1445 N BELL ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3534
Practice Address - Country:US
Practice Address - Phone:402-512-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist