Provider Demographics
NPI:1962661298
Name:ULFFERS, JACOB D (DPT)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:ULFFERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 READ ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-5213
Mailing Address - Country:US
Mailing Address - Phone:402-660-2538
Mailing Address - Fax:
Practice Address - Street 1:8920 READ ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-5213
Practice Address - Country:US
Practice Address - Phone:402-660-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39517OtherBLUE CROSS BLUE SHIELD
NEP00657469OtherRR MEDICARE
NE098958003Medicare PIN