Healthcare Provider Details

I. General information

NPI: 1427283589
Provider Name (Legal Business Name): NATHAN DANIEL DICKES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11757 S HIGHWAY 6 STE 1
GRETNA NE
68028-8077
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-905-9089
  • Fax: 402-504-4671
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2740
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: