Provider Demographics
NPI:1073273595
Name:MANHOLD, JARED MICHAEL
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:MANHOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 TIPPERARY TRL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-1462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 N 8TH ST
Practice Address - Street 2:
Practice Address - City:LOUP CITY
Practice Address - State:NE
Practice Address - Zip Code:68853-8215
Practice Address - Country:US
Practice Address - Phone:402-440-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1783225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant