Provider Demographics
NPI:1255535548
Name:GIAMBELLUCA, JUSTIN M SR (PTA)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:GIAMBELLUCA
Suffix:SR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N 90TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2761
Mailing Address - Country:US
Mailing Address - Phone:225-610-7951
Mailing Address - Fax:
Practice Address - Street 1:400 E BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:HOOPER
Practice Address - State:NE
Practice Address - Zip Code:68031-3002
Practice Address - Country:US
Practice Address - Phone:402-654-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant