Healthcare Provider Details

I. General information

NPI: 1114375508
Provider Name (Legal Business Name): OLIVIA HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S 56TH ST STE 314
LINCOLN NE
68516-1889
US

IV. Provider business mailing address

5400 S 56TH ST STE 314
LINCOLN NE
68516-1889
US

V. Phone/Fax

Practice location:
  • Phone: 531-500-3259
  • Fax:
Mailing address:
  • Phone: 531-500-3259
  • Fax: 531-500-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-05325
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: