Provider Demographics
NPI:1588959498
Name:ROUGHEAD, JANNA (DPT)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:ROUGHEAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 S 133RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5905
Mailing Address - Country:US
Mailing Address - Phone:402-330-8433
Mailing Address - Fax:402-330-8616
Practice Address - Street 1:2206 LONGO DR STE 211
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2977
Practice Address - Country:US
Practice Address - Phone:402-291-1963
Practice Address - Fax:402-291-1966
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist