Provider Demographics
NPI:1669522371
Name:DAIGLE, JEAN T (PT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:T
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 L ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1553
Mailing Address - Country:US
Mailing Address - Phone:402-731-8888
Mailing Address - Fax:402-731-8090
Practice Address - Street 1:4930 L ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1553
Practice Address - Country:US
Practice Address - Phone:402-731-8888
Practice Address - Fax:402-731-8090
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39549OtherBLUE CROSS BLUE SHIELD
NE47074908500Medicaid