Healthcare Provider Details

I. General information

NPI: 1982199394
Provider Name (Legal Business Name): JOEL WARDEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FORT CROOK RD N STE 202
BELLEVUE NE
68005-4226
US

IV. Provider business mailing address

4683 PIERCE ST
OMAHA NE
68106-2031
US

V. Phone/Fax

Practice location:
  • Phone: 402-763-4408
  • Fax:
Mailing address:
  • Phone: 660-909-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number14239-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0015755
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1323881
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4256
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: