Provider Demographics
NPI:1841510831
Name:JAEKE, DANELLE J (MPT)
Entity type:Individual
Prefix:
First Name:DANELLE
Middle Name:J
Last Name:JAEKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:DANELLE
Other - Middle Name:J
Other - Last Name:FRAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:117 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6743
Mailing Address - Country:US
Mailing Address - Phone:402-750-6612
Mailing Address - Fax:
Practice Address - Street 1:930 2ND ST
Practice Address - Street 2:
Practice Address - City:DODGE
Practice Address - State:NE
Practice Address - Zip Code:68633
Practice Address - Country:US
Practice Address - Phone:402-693-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist