Provider Demographics
NPI:1386781854
Name:JANECZKO, LINDA E (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:JANECZKO
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 1:506 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4154
Mailing Address - Country:US
Mailing Address - Phone:402-339-8705
Mailing Address - Fax:402-339-3157
Practice Address - Street 1:506 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4154
Practice Address - Country:US
Practice Address - Phone:402-339-8705
Practice Address - Fax:402-339-3157
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7472251P0200X
MN9272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-071456700Medicaid
NE09111OtherBC BS OF NEBRASKA