Provider Demographics
NPI:1356709323
Name:LURZ, STEPHANIE LYN (PTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYN
Last Name:LURZ
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 1:103 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MEADOW GROVE
Mailing Address - State:NE
Mailing Address - Zip Code:68752-4013
Mailing Address - Country:US
Mailing Address - Phone:402-851-3380
Mailing Address - Fax:
Practice Address - Street 1:900 W NORFOLK AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5006
Practice Address - Country:US
Practice Address - Phone:402-851-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072729225200000X
NE1143225200000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant