Provider Demographics
NPI:1619225893
Name:GENTLEMAN, JULIE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GENTLEMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 90TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2764
Mailing Address - Country:US
Mailing Address - Phone:402-926-4444
Mailing Address - Fax:
Practice Address - Street 1:1000 N 90TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2764
Practice Address - Country:US
Practice Address - Phone:402-926-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18682251G0304X
IA030132251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics