Healthcare Provider Details

I. General information

NPI: 1760815971
Provider Name (Legal Business Name): DYNAMIC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 402-905-9089
  • Fax: 402-504-4671
Mailing address:
  • Phone: 402-905-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2433
License Number StateNE

VIII. Authorized Official

Name: ANDREW JAMES CONSBRUCK
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 402-905-9089