Healthcare Provider Details

I. General information

NPI: 1568837482
Provider Name (Legal Business Name): LINCOLN ORTHOPEDIC PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 N 26TH ST STE 100
LINCOLN NE
68521-4748
US

IV. Provider business mailing address

1651 N 86TH ST STE 100
LINCOLN NE
68505-3719
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-5361
  • Fax:
Mailing address:
  • Phone: 402-484-7117
  • Fax: 402-484-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN DEWAARD JR.
Title or Position: OWNER
Credential:
Phone: 402-484-7117