Provider Demographics
NPI:1619085628
Name:JANSA, LORI L (DPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:JANSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:JOHNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1919 S. 40TH ST
Mailing Address - Street 2:SUITE 335
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5248
Mailing Address - Country:US
Mailing Address - Phone:402-420-2500
Mailing Address - Fax:402-420-2501
Practice Address - Street 1:1919 S. 40TH ST
Practice Address - Street 2:SUITE 335
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5248
Practice Address - Country:US
Practice Address - Phone:402-420-2500
Practice Address - Fax:402-420-2501
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02167OtherBCBS
NE02167OtherBCBS
280468Medicare PIN