Provider Demographics
NPI:1073382347
Name:LOTKER, JORDAN BRIANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:BRIANN
Last Name:LOTKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:76445 ROAD 425
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-5300
Mailing Address - Country:US
Mailing Address - Phone:308-991-7551
Mailing Address - Fax:
Practice Address - Street 1:313 E 12TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1506
Practice Address - Country:US
Practice Address - Phone:308-784-2231
Practice Address - Fax:308-784-3449
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1467225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant