Healthcare Provider Details

I. General information

NPI: 1740398767
Provider Name (Legal Business Name): KIRK W LAUGHLIN MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 N 26TH ST STE 400
LINCOLN NE
68521-4768
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 402-742-8410
  • Fax: 402-742-8411
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1012
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: