Provider Demographics
NPI:1134455645
Name:SYMANSKI, JESSICA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:SYMANSKI
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 1:8 FAIRCHILD CIR
Mailing Address - Street 2:
Mailing Address - City:OFFUTT A F B
Mailing Address - State:NE
Mailing Address - Zip Code:68113-1010
Mailing Address - Country:US
Mailing Address - Phone:402-350-3443
Mailing Address - Fax:
Practice Address - Street 1:7410 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2317
Practice Address - Country:US
Practice Address - Phone:402-350-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant