Healthcare Provider Details

I. General information

NPI: 1134775869
Provider Name (Legal Business Name): RACHEL WITKOVSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5336
US

IV. Provider business mailing address

13616 CALIFORNIA ST STE 100
OMAHA NE
68154-5336
US

V. Phone/Fax

Practice location:
  • Phone: 402-496-0404
  • Fax:
Mailing address:
  • Phone: 402-496-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4291
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: