Healthcare Provider Details

I. General information

NPI: 1649104530
Provider Name (Legal Business Name): NICHOLAS SCOTT WALTER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 S 42ND ST STE 106
BELLEVUE NE
68123-1089
US

IV. Provider business mailing address

2929 CALIFORNIA PLZ APT 2360
OMAHA NE
68131-1547
US

V. Phone/Fax

Practice location:
  • Phone: 402-502-4678
  • Fax: 402-933-9137
Mailing address:
  • Phone: 402-502-4678
  • Fax: 402-933-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4957
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: