Provider Demographics
NPI:1598920662
Name:LEBSACK, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:LEBSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:LINDSTEADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1898
Mailing Address - Country:US
Mailing Address - Phone:402-984-1487
Mailing Address - Fax:
Practice Address - Street 1:7660 KNOX CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4540
Practice Address - Country:US
Practice Address - Phone:402-984-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2653225100000X
COPTL0011319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48858269Medicaid
NE10025288900Medicaid