Provider Demographics
NPI:1740499243
Name:JOLITO, ALAN JEREZA (PT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JEREZA
Last Name:JOLITO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-5647
Mailing Address - Country:US
Mailing Address - Phone:402-477-7241
Mailing Address - Fax:402-477-7241
Practice Address - Street 1:3220 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-2121
Practice Address - Country:US
Practice Address - Phone:402-476-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist