Provider Demographics
NPI:1861856270
Name:JABLONSKI, AMBER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NORMAL ST
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:IA
Mailing Address - Zip Code:51579-1029
Mailing Address - Country:US
Mailing Address - Phone:402-490-1863
Mailing Address - Fax:
Practice Address - Street 1:1110 NORMAL ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:IA
Practice Address - Zip Code:51579-1029
Practice Address - Country:US
Practice Address - Phone:402-490-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078337225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant