Provider Demographics
NPI:1275719585
Name:NUTTELMAN, JESSICA MARIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:NUTTELMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 COUNTY ROAD P49
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-5144
Mailing Address - Country:US
Mailing Address - Phone:402-990-1791
Mailing Address - Fax:402-721-4154
Practice Address - Street 1:823 M ST
Practice Address - Street 2:
Practice Address - City:TEKAMAH
Practice Address - State:NE
Practice Address - Zip Code:68061-1427
Practice Address - Country:US
Practice Address - Phone:402-990-1791
Practice Address - Fax:402-721-4154
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist