Healthcare Provider Details

I. General information

NPI: 1649550070
Provider Name (Legal Business Name): NICOLE SOVA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 LONGO DR SUITE 211
BELLEVUE NE
68005-2901
US

IV. Provider business mailing address

2403 S 133RD PLZ
OMAHA NE
68144-5905
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-1963
  • Fax:
Mailing address:
  • Phone: 402-330-8433
  • Fax: 402-330-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3018
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004852
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: