Provider Demographics
NPI:1235309022
Name:VLCEK, JEANNE S (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:S
Last Name:VLCEK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:S
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11151 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3873
Mailing Address - Country:US
Mailing Address - Phone:402-210-7177
Mailing Address - Fax:
Practice Address - Street 1:8642 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1639
Practice Address - Country:US
Practice Address - Phone:402-393-9390
Practice Address - Fax:402-393-9388
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2629OtherSTATE LICENSE