Healthcare Provider Details

I. General information

NPI: 1457513418
Provider Name (Legal Business Name): OMAHA THERAPY DBA REHAB VISIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 STATE AVE STE B
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

683 STATE AVE STE B
DICKINSON ND
58601-4660
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9400
  • Fax: 701-483-9398
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1504
License Number StateND

VIII. Authorized Official

Name: JEAN HERAUF
Title or Position: AREA MANAGER
Credential:
Phone: 701-483-9400