Healthcare Provider Details

I. General information

NPI: 1437330495
Provider Name (Legal Business Name): ALVIN ORTEGA BENEMERITO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E SOUTH ST RCH REHAB DEPARTMENT
BASSETT NE
68714-5508
US

IV. Provider business mailing address

PO BOX 38 621 NORTH MAIN ST
LONG PINE NE
69217-0038
US

V. Phone/Fax

Practice location:
  • Phone: 402-684-3366
  • Fax: 413-431-5660
Mailing address:
  • Phone: 402-273-3164
  • Fax: 413-431-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1353
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0932
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: