Healthcare Provider Details

I. General information

NPI: 1528044211
Provider Name (Legal Business Name): EDSEN DONATO PT, DSC, OCS, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S 48TH ST
LINCOLN NE
68506-4345
US

IV. Provider business mailing address

3800 S 48TH ST
LINCOLN NE
68506-4345
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-2528
  • Fax: 402-486-2578
Mailing address:
  • Phone: 402-486-2528
  • Fax: 402-486-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4577
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: