Provider Demographics
NPI:1336775592
Name:BREUER, JENNIFER BERNICE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BERNICE
Last Name:BREUER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BERNICE
Other - Last Name:RUDOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1100 T ST
Mailing Address - Street 2:
Mailing Address - City:NELIGH
Mailing Address - State:NE
Mailing Address - Zip Code:68756-1027
Mailing Address - Country:US
Mailing Address - Phone:402-887-5428
Mailing Address - Fax:
Practice Address - Street 1:1100 T ST
Practice Address - Street 2:
Practice Address - City:NELIGH
Practice Address - State:NE
Practice Address - Zip Code:68756-1027
Practice Address - Country:US
Practice Address - Phone:402-887-5428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1502225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant