Healthcare Provider Details

I. General information

NPI: 1053470823
Provider Name (Legal Business Name): HORIZON PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S. 40TH ST. SUITE 335
LINCOLN NE
68506-5248
US

IV. Provider business mailing address

1919 S. 40TH ST. SUITE 335
LINCOLN NE
68506-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-2500
  • Fax: 402-420-2501
Mailing address:
  • Phone: 402-420-2500
  • Fax: 402-420-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1655
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNE

VIII. Authorized Official

Name: MR. SHANE MICHAEL JANSA
Title or Position: CLINIC OWNER
Credential: MSPT
Phone: 402-420-2500