Healthcare Provider Details

I. General information

NPI: 1740503739
Provider Name (Legal Business Name): CODDINGTON PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S CODDINGTON AVE SUITE C
LINCOLN NE
68522-4402
US

IV. Provider business mailing address

1550 S CODDINGTON AVE STE C
LINCOLN NE
68522-4402
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-0303
  • Fax: 402-423-0202
Mailing address:
  • Phone: 402-423-0303
  • Fax: 402-423-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CASEY JONATHAN MOELLER
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: D.P.T. B.S.
Phone: 402-826-2255