Healthcare Provider Details

I. General information

NPI: 1831306539
Provider Name (Legal Business Name): BROR CHRISTER LJUNGQVIST P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E 23RD ST SUITE 200
FREMONT NE
68025-0800
US

IV. Provider business mailing address

4613 COPPER RIDGE RD
CHAMPAIGN IL
61822-9719
US

V. Phone/Fax

Practice location:
  • Phone: 866-784-2329
  • Fax:
Mailing address:
  • Phone: 217-972-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: