Healthcare Provider Details

I. General information

NPI: 1184627911
Provider Name (Legal Business Name): GO PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N DIERS AVE SUITE 300
GRAND ISLAND NE
68803-4985
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax: 308-382-3241
Mailing address:
  • Phone: 308-382-0344
  • Fax: 308-382-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number681
License Number StateNE

VIII. Authorized Official

Name: KENDRA BRUMMUND
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 308-675-1853