Provider Demographics
NPI:1164717567
Name:ATTANASIO, JINAE PATRICIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JINAE
Middle Name:PATRICIA
Last Name:ATTANASIO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 N 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3928
Mailing Address - Country:US
Mailing Address - Phone:402-551-2110
Mailing Address - Fax:
Practice Address - Street 1:2824 N 66TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3928
Practice Address - Country:US
Practice Address - Phone:402-551-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE999225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant