Organization
DYNAMIC LIFE THERAPY AND WELLNESS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAREE JO FEJFAR-JEDLICKA PT (PRESIDENT/OWNER)
(402) 606-4492
Entity
Organization
Contact information
Practice address
3763 39TH AVE, SUITE 100, COLUMBUS, NE 68601-4504
(402) 606-4492
(402) 615-4168
Mailing address
3763 39TH AVE, SUITE 100, COLUMBUS, NE 68601-4504
(402) 606-4492
(402) 606-4168
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1752
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025818800
—
NE
Enumeration date
01/23/2010
Last updated
06/03/2013
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