Healthcare Provider Details

I. General information

NPI: 1699728360
Provider Name (Legal Business Name): ROBERT F DENELL PT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 VILLAGE DR
LINCOLN NE
68516-4735
US

IV. Provider business mailing address

1651 N 86TH ST SUITE 100
LINCOLN NE
68505-3718
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-2626
  • Fax: 402-420-6502
Mailing address:
  • Phone: 402-484-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number296
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: