Healthcare Provider Details

I. General information

NPI: 1922930858
Provider Name (Legal Business Name): KOBY SCOTT BRANDENBURG DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 S 34TH ST STE 100
LINCOLN NE
68516-6242
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 531-214-4927
  • Fax: 531-249-5015
Mailing address:
  • Phone: 531-214-4927
  • Fax: 531-249-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4941
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: