Provider Demographics
NPI:1710284294
Name:MEYSENBURG, JAMEE LYNN (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:JAMEE
Middle Name:LYNN
Last Name:MEYSENBURG
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 S 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2501
Mailing Address - Country:US
Mailing Address - Phone:402-333-0539
Mailing Address - Fax:402-333-0622
Practice Address - Street 1:2275 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2501
Practice Address - Country:US
Practice Address - Phone:402-333-0539
Practice Address - Fax:402-333-0622
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE514225200000X
NE1862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer