Healthcare Provider Details

I. General information

NPI: 1477961647
Provider Name (Legal Business Name): EVAN VOLZKE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 LAKE PARK LN
HASTINGS NE
68901-2508
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
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 Number3360
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: