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Individual

MR. LANCE DESTEFANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1622 WALNUT ST, SYRACUSE, NE 68446-7017
(402) 269-2251
Mailing address
9785 FOWLER DR, PAPILLION, NE 68046-4548
(402) 339-2410

Taxonomy

Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
827
NE

Other

Enumeration date
04/17/2009
Last updated
04/17/2009
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