Provider Demographics
NPI:1255392916
Name:REERINK, JODI RAE (PT)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:RAE
Last Name:REERINK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:RAE
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2728 N 108TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3763
Mailing Address - Country:US
Mailing Address - Phone:402-939-7939
Mailing Address - Fax:402-939-7940
Practice Address - Street 1:2728 N 108TH ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3763
Practice Address - Country:US
Practice Address - Phone:402-939-7939
Practice Address - Fax:402-939-7940
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09134OtherBCBS
IA0577791Medicaid
IA0577791Medicaid
NE09134OtherBCBS