Healthcare Provider Details

I. General information

NPI: 1710239447
Provider Name (Legal Business Name): EAST CENTRAL NEBRASKA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W 6TH ST
NORTH BEND NE
68649-4430
US

IV. Provider business mailing address

PO BOX 211
DAVID CITY NE
68632-0211
US

V. Phone/Fax

Practice location:
  • Phone: 402-652-8201
  • Fax: 402-652-8202
Mailing address:
  • Phone: 402-367-7728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. KELLEN BENES
Title or Position: PARTNER OWNER
Credential: DPT
Phone: 402-652-8201