Provider Demographics
NPI:1396043121
Name:DEJANO, ROGELIO JR (ROGELIO DEJANO)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:DEJANO
Suffix:JR
Gender:M
Credentials:ROGELIO DEJANO
Other - Prefix:
Other - First Name:ROGELIO
Other - Middle Name:
Other - Last Name:DEJANO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:ROGELIO DEJANO
Mailing Address - Street 1:16962 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3162
Mailing Address - Country:US
Mailing Address - Phone:402-213-5170
Mailing Address - Fax:
Practice Address - Street 1:2319 N 163RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2537
Practice Address - Country:US
Practice Address - Phone:402-213-5170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist