Provider Demographics
NPI:1669690343
Name:MERRITT, JANICE JEAN (MPT)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:JEAN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15480 HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2706
Mailing Address - Country:US
Mailing Address - Phone:402-334-9024
Mailing Address - Fax:
Practice Address - Street 1:2808 S 143RD PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5611
Practice Address - Country:US
Practice Address - Phone:402-637-0698
Practice Address - Fax:402-637-0697
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist