Healthcare Provider Details

I. General information

NPI: 1578595625
Provider Name (Legal Business Name): TEAM PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SOUTH 1ST AVENUE
BROKEN BOW NE
68822-2331
US

IV. Provider business mailing address

PO BOX 435
BROKEN BOW NE
68822-0435
US

V. Phone/Fax

Practice location:
  • Phone: 308-872-5111
  • Fax: 308-872-5115
Mailing address:
  • Phone: 308-872-5111
  • Fax: 308-872-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF DENSON
Title or Position: DIRECTOR OF OPERATIONS & PERSONNEL
Credential: PT
Phone: 308-872-5111