Healthcare Provider Details

I. General information

NPI: 1730280371
Provider Name (Legal Business Name): OMAHA THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 STATE AVE STE B
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

11623 ARBOR ST STE 200
OMAHA NE
68144-2991
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-9400
  • Fax: 701-483-9398
Mailing address:
  • Phone: 402-334-6025
  • Fax: 402-334-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA LYNN GODFREY
Title or Position: SENIOR ACCOUNTANT/DELEGATED OFFICIA
Credential:
Phone: 402-334-6025