Provider Demographics
NPI:1750685186
Name:JEFFREY, GEORGE RANDY (PT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:RANDY
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N COTNER
Mailing Address - Street 2:# 125
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-464-6141
Mailing Address - Fax:402-464-6142
Practice Address - Street 1:770 N COTNER
Practice Address - Street 2:# 125
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505
Practice Address - Country:US
Practice Address - Phone:402-464-6141
Practice Address - Fax:402-464-6142
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist