Basic Information
Provider Information
NPI: 1003142126
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAXA
FirstName: JAMES
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7712 N 80TH AVE
Address2:  
City: OMAHA
State: NE
PostalCode: 681222602
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 7712 N 80TH AVE
Address2:  
City: OMAHA
State: NE
PostalCode: 681222602
CountryCode: US
TelephoneNumber: 4023197396
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/23/2009
LastUpdateDate: 10/23/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X03934IAN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225100000X2462NEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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