Healthcare Provider Details

I. General information

NPI: 1144287897
Provider Name (Legal Business Name): CROSSROADS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 S 56TH ST SUITE # 1
LINCOLN NE
68516-3392
US

IV. Provider business mailing address

6101 S 56TH ST SUITE # 1
LINCOLN NE
68516-3392
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-0800
  • Fax: 402-420-0801
Mailing address:
  • Phone: 402-420-0800
  • Fax: 402-420-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number018829772
License Number StateNE

VIII. Authorized Official

Name: CONNIE SUE HORNE
Title or Position: PHYSICAL THERAPIST OWNER
Credential: MSPT
Phone: 402-420-0800