Provider Demographics
NPI:1700284189
Name:DENTLINGER, JOHN ROGER (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROGER
Last Name:DENTLINGER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2201
Mailing Address - Country:US
Mailing Address - Phone:712-369-0227
Mailing Address - Fax:
Practice Address - Street 1:2305 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1108
Practice Address - Country:US
Practice Address - Phone:402-345-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist