Healthcare Provider Details

I. General information

NPI: 1740057009
Provider Name (Legal Business Name): DARIN LEE BOTTGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N 26TH ST STE 104
LINCOLN NE
68521-4746
US

IV. Provider business mailing address

3700 W ROSE ST
LINCOLN NE
68522-9250
US

V. Phone/Fax

Practice location:
  • Phone: 402-465-0010
  • Fax:
Mailing address:
  • Phone: 308-760-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4007
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: