| Dynamic Life Therapy And Wellness Pc | |
|
3763 39th Ave Suite 100 Columbus NE 68601-4504 | |
| (402) 606-4492 | |
| (402) 615-4168 |
| Full Name | Dynamic Life Therapy And Wellness Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3763 39th Ave, Columbus, Nebraska |
| Authorized Official Name and Position | Sharee Jo Fejfar-jedlicka (PRESIDENT/OWNER) |
| Authorized Official Contact | 4026064492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dynamic Life Therapy And Wellness Pc 3763 39th Ave Suite 100 Columbus NE 68601-4504 Ph: (402) 606-4492 | Dynamic Life Therapy And Wellness Pc 3763 39th Ave Suite 100 Columbus NE 68601-4504 Ph: (402) 606-4492 |
| NPI Number | 1083945554 |
|---|---|
| Provider Enumeration Date | 01/23/2010 |
| Last Update Date | 06/03/2013 |
| Medicare PECOS PAC ID | 0648309591 |
|---|---|
| Medicare Enrollment ID | O20150626000218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083945554 | NPI | - | NPPES |
| 10025818800 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1752 (Nebraska) | Primary |
| Provider Name | Sharee J Fejfar Jedlicka |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1538494034 PECOS PAC ID: 7719875343 Enrollment ID: I20040305001040 |
| Provider Name | Melissa A Truksa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1275732539 PECOS PAC ID: 9032204839 Enrollment ID: I20071008000500 |
| Provider Name | Kelly M Cameron |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437596400 PECOS PAC ID: 2365685898 Enrollment ID: I20130830000354 |
| Provider Name | Elizabeth A. Gonka |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437356995 PECOS PAC ID: 5991924128 Enrollment ID: I20140919000977 |
| Provider Name | Rachel Lynn Koch |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1396143350 PECOS PAC ID: 5092030429 Enrollment ID: I20150206000511 |
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