Healthcare Provider Details

I. General information

NPI: 1780996033
Provider Name (Legal Business Name): PEAK PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S 85TH ST SUITE 101
LINCOLN NE
68526-9231
US

IV. Provider business mailing address

5900 S 85TH ST SUITE 101
LINCOLN NE
68526-9231
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-7325
  • Fax: 402-423-7328
Mailing address:
  • Phone: 402-423-7325
  • Fax: 402-423-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1976
License Number StateNE

VIII. Authorized Official

Name: JEFF BOOHER
Title or Position: MANAGER
Credential: PT, ATC
Phone: 402-423-7325