Healthcare Provider Details

I. General information

NPI: 1942041868
Provider Name (Legal Business Name): ERIN KUJATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 H ST
FAIRBURY NE
68352-1119
US

IV. Provider business mailing address

71270 564TH AVE
FAIRBURY NE
68352-5025
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-3351
  • Fax:
Mailing address:
  • Phone: 402-587-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2091
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: