Healthcare Provider Details

I. General information

NPI: 1598719353
Provider Name (Legal Business Name): LINCOLN ORTHOPEDIC PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 N 86TH ST STE 100
LINCOLN NE
68505-3719
US

IV. Provider business mailing address

1651 N 86TH ST STE 100
LINCOLN NE
68505-3719
US

V. Phone/Fax

Practice location:
  • Phone: 402-484-7117
  • Fax: 402-484-7118
Mailing address:
  • Phone: 402-484-7117
  • Fax: 402-484-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN DEWAARD JR.
Title or Position: OWNER
Credential:
Phone: 402-484-7117