Provider Demographics
NPI:1245200492
Name:JOHNSEN, JEREMIAH J (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:J
Last Name:JOHNSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 S LOCUST ST.
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801
Mailing Address - Country:US
Mailing Address - Phone:308-382-9700
Mailing Address - Fax:308-382-9898
Practice Address - Street 1:929 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6751
Practice Address - Country:US
Practice Address - Phone:308-382-9700
Practice Address - Fax:308-382-9898
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist