Provider Demographics
NPI:1174573620
Name:JUNGE, DOUGLAS JOHN (MPT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:JUNGE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W BENJAMIN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2769
Mailing Address - Country:US
Mailing Address - Phone:402-371-9707
Mailing Address - Fax:402-371-9719
Practice Address - Street 1:1220 W BENJAMIN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2769
Practice Address - Country:US
Practice Address - Phone:402-371-9707
Practice Address - Fax:402-371-9719
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076638113Medicaid
NE266301Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER