Provider Demographics
NPI:1275034431
Name:LAMARCHE, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:LAMARCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 S 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2410
Mailing Address - Country:US
Mailing Address - Phone:402-616-9306
Mailing Address - Fax:
Practice Address - Street 1:5184 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-6706
Practice Address - Country:US
Practice Address - Phone:720-372-0865
Practice Address - Fax:720-386-3392
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENO2255A2300X
COPTL.0020266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer