Healthcare Provider Details

I. General information

NPI: 1356820989
Provider Name (Legal Business Name): JUSTIN L BLATCHFORD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20502 ROOSEVELT ST
ELKHORN NE
68022-4148
US

IV. Provider business mailing address

10118 MAPLE ST
OMAHA NE
68134-5555
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8181
  • Fax:
Mailing address:
  • Phone: 402-939-7939
  • Fax: 402-939-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3881
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3881
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3881
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: