Healthcare Provider Details

I. General information

NPI: 1891846572
Provider Name (Legal Business Name): LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SUPERIOR ST STE 100
LINCOLN NE
68521-4155
US

IV. Provider business mailing address

6940 VAN DORN ST STE 103
LINCOLN NE
68506-2858
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-2600
  • Fax:
Mailing address:
  • Phone: 402-483-4709
  • Fax: 402-483-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0773441DPC
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNE

VIII. Authorized Official

Name: CHAD WEMHOFF
Title or Position: OWNER/ PT
Credential:
Phone: 402-421-2700