Provider Demographics
NPI:1710548292
Name:BRESTER, JORDAN SUE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:SUE
Last Name:BRESTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:SUE
Other - Last Name:CHOHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:706 EWING AVENUE
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:NE
Mailing Address - Zip Code:68640
Mailing Address - Country:US
Mailing Address - Phone:402-993-4599
Mailing Address - Fax:402-993-7024
Practice Address - Street 1:706 EWING AVENUE
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:NE
Practice Address - Zip Code:68640
Practice Address - Country:US
Practice Address - Phone:402-993-4599
Practice Address - Fax:402-993-7024
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3972225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE3972OtherPT LICENSE