Provider Demographics
NPI:1811960909
Name:JEFFREY, SUSAN KAY (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:JEFFREY
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 1:770 N COTNER BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2310
Mailing Address - Country:US
Mailing Address - Phone:402-464-6141
Mailing Address - Fax:402-464-6142
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-464-6141
Practice Address - Fax:402-464-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist