Active NPI
Jennifer Leigh Memolo, PTA
- Physical Therapy Assistant
- Papillion, NE
National Provider Identifier
1831478072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 837
- Practice address
- 1507 E Gold Coast Rd
Papillion, NE 68046-4722 - Phone
- (402) 339-6010
- NPI assigned
- Aug 5, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 837 | NE | Primary |
Addresses
Primary practice location
1507 E Gold Coast Rd
Papillion, NE 68046-4722
Mailing address
7317 N 108TH St
Omaha, NE 68142-1109
Phone (402) 972-5890
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 837 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312502400000",
"number": "1831478072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7317 N 108TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681421109",
"telephone_number": "402-972-5890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1507 E GOLD COAST RD",
"city": "PAPILLION",
"state": "NE",
"postal_code": "680464722",
"telephone_number": "402-339-6010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEMOLO",
"first_name": "JENNIFER",
"middle_name": "LEIGH",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-05",
"last_updated": "2011-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Papillion, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.