Healthcare Provider Details

I. General information

NPI: 1760992416
Provider Name (Legal Business Name): ENCORE PREAKNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S 58TH ST STE C
LINCOLN NE
68516-3695
US

IV. Provider business mailing address

4025 TAMPA RD STE 1106
OLDSMAR FL
34677-3213
US

V. Phone/Fax

Practice location:
  • Phone: 402-421-1142
  • Fax: 402-421-1167
Mailing address:
  • Phone: 888-974-7878
  • Fax: 727-726-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUE E OLSEN
Title or Position: VICE PRESIDENT
Credential:
Phone: 888-974-7878