Provider Demographics
NPI:1649368770
Name:EBERLE, JENNY K (DPT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:K
Last Name:EBERLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:K
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4984
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:308-382-3241
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39989OtherBLUE CROSS BLUE SHIELD
278616Medicare ID - Type Unspecified