Provider Demographics
NPI:1184241457
Name:LUNZ, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:LUNZ
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 1:1305 HIGHWAY 6 34
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-6616
Mailing Address - Country:US
Mailing Address - Phone:308-697-4178
Mailing Address - Fax:308-697-4179
Practice Address - Street 1:1305 HIGHWAY 6 34
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022-6616
Practice Address - Country:US
Practice Address - Phone:308-697-4178
Practice Address - Fax:308-697-4179
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist