Healthcare Provider Details

I. General information

NPI: 1154064947
Provider Name (Legal Business Name): NIA RHYANN VOTTA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

2039 MORNINGSIDE RD APT 133
FREMONT NE
68025-8923
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-3795
  • Fax:
Mailing address:
  • Phone: 402-992-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1916
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: