Provider Demographics
NPI:1548239361
Name:LORD, MARIAN JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:JEAN
Last Name:LORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 DUPONT CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2153
Mailing Address - Country:US
Mailing Address - Phone:402-334-6213
Mailing Address - Fax:402-334-6218
Practice Address - Street 1:14441 DUPONT CT
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2153
Practice Address - Country:US
Practice Address - Phone:402-334-6213
Practice Address - Fax:402-334-6218
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09205OtherBLUE CROSS
NEF247007OtherMIDLANDS CHOICE
NE47084030832Medicaid
NENA1244001OtherMEDICARE PTAN