Healthcare Provider Details

I. General information

NPI: 1639568116
Provider Name (Legal Business Name): HEARTLAND EQUINE THERAPEUTIC RIDING ACADEMY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 S 222ND ST
GRETNA NE
68028-4317
US

IV. Provider business mailing address

10130 S 222ND ST
GRETNA NE
68028-4317
US

V. Phone/Fax

Practice location:
  • Phone: 402-359-8830
  • Fax:
Mailing address:
  • Phone: 402-359-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: EDYE GODDEN
Title or Position: EXECUTIVE DIRECTOR
Credential: OTR/L
Phone: 402-359-8830