Healthcare Provider Details

I. General information

NPI: 1790414373
Provider Name (Legal Business Name): WHITNEY LEIGH RODRIGUEZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY LEIGH BENDORF PT, DPT

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 CIMARRON PLZ STE 105
HASTINGS NE
68901-2883
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-463-2077
  • Fax: 402-463-2062
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 Number4355
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: