NPIMap

Organization Active NPI

Dynamic Life Therapy and Wellness PC

  • Clinic/Center
  • Columbus, NE
National Provider Identifier
1083945554
Registry record updated Jun 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1752 Issued in NE
Legal business name
DYNAMIC LIFE THERAPY AND WELLNESS PC
Practice address
3763 39TH Ave
Suite 100
Columbus, NE 68601-4504
Phone
(402) 606-4492
Fax
(402) 615-4168
NPI assigned
Jan 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharee Jo Fejfar-Jedlicka, PTNPI 1538494034
Title
President/Owner
Phone
(402) 606-4492

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1752 NE Primary

Addresses

Primary practice location

3763 39TH Ave
Suite 100
Columbus, NE 68601-4504

Mailing address

3763 39TH Ave
Suite 100
Columbus, NE 68601-4504
Phone (402) 606-4492

Other identifiers 1

IdentifierTypeStateIssuer
10025818800MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150626000218 NE Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0648309591 Receives reassigned benefits from 2 practitioners
Practice locations: Columbus, NE

National Provider Directory

National Provider Directory

Locations

3763 39th Ave
Ste 100
Columbus, NE 68601
Phone (402) 316-4027

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370217600000",
    "number": "1083945554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3763 39TH AVE",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "NE",
            "postal_code": "686014504",
            "telephone_number": "402-606-4492",
            "fax_number": "402-606-4168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3763 39TH AVE",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "NE",
            "postal_code": "686014504",
            "telephone_number": "402-606-4492",
            "fax_number": "402-615-4168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC LIFE THERAPY AND WELLNESS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-23",
        "last_updated": "2013-06-03",
        "status": "A",
        "authorized_official_last_name": "FEJFAR-JEDLICKA",
        "authorized_official_first_name": "SHAREE",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "402-606-4492",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NE",
            "license": "1752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025818800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.