Healthcare Provider Details

I. General information

NPI: 1447780358
Provider Name (Legal Business Name): LAURA BUTLER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA RUSKAMP

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 FALLBROOK BLVD STE 200
LINCOLN NE
68521-9042
US

IV. Provider business mailing address

6825 S 27TH ST STE 103
LINCOLN NE
68512-4872
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-0020
  • Fax: 402-420-0014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3724
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: