Healthcare Provider Details

I. General information

NPI: 1366793887
Provider Name (Legal Business Name): JUSTIN SCHARDT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 H ST
FAIRBURY NE
68352-1119
US

IV. Provider business mailing address

4911 N 26TH ST
LINCOLN NE
68521-4739
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-6840
  • Fax: 402-729-3508
Mailing address:
  • Phone: 402-477-3110
  • Fax: 402-477-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2899
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: