Healthcare Provider Details

I. General information

NPI: 1568600765
Provider Name (Legal Business Name): SCOTT A KLEINSCHMIDT MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N DARR AVE
GRAND ISLAND NE
68803-4635
US

IV. Provider business mailing address

1110 H ST
GENEVA NE
68361-2014
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-2635
  • Fax:
Mailing address:
  • Phone: 402-759-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2177
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number03636
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: