Provider Demographics
NPI:1225228521
Name:BERANEK, JEREMY DEAN (ATC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DEAN
Last Name:BERANEK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16118 EMILINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136
Mailing Address - Country:US
Mailing Address - Phone:402-504-9789
Mailing Address - Fax:
Practice Address - Street 1:16118 EMILINE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136
Practice Address - Country:US
Practice Address - Phone:402-504-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer