Healthcare Provider Details

I. General information

NPI: 1487067518
Provider Name (Legal Business Name): SANDQUIST MFR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 O ST SUITE 201K
LINCOLN NE
68510-1600
US

IV. Provider business mailing address

3701 O ST SUITE 201K
LINCOLN NE
68510-1600
US

V. Phone/Fax

Practice location:
  • Phone: 402-617-9904
  • Fax:
Mailing address:
  • Phone: 402-617-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number237
License Number StateNE

VIII. Authorized Official

Name: MS. KATHRYN A SANDQUIST
Title or Position: MANAGER
Credential: PT
Phone: 402-617-9904