Provider Demographics
NPI:1538494034
Name:FEJFAR-JEDLICKA, SHAREE JO (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:SHAREE
Middle Name:JO
Last Name:FEJFAR-JEDLICKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:SHAREE
Other - Middle Name:JO
Other - Last Name:FEJFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3763 39TH AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4504
Mailing Address - Country:US
Mailing Address - Phone:402-615-0183
Mailing Address - Fax:
Practice Address - Street 1:3763 39TH AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4504
Practice Address - Country:US
Practice Address - Phone:402-615-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist