Healthcare Provider Details

I. General information

NPI: 1144515552
Provider Name (Legal Business Name): KATHLEEN LAX DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13336 INDUSTRIAL RD SUITE 105
OMAHA NE
68137-1124
US

IV. Provider business mailing address

13336 INDUSTRIAL RD SUITE 105
OMAHA NE
68137-1124
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-3211
  • Fax: 402-330-5970
Mailing address:
  • Phone: 402-330-3211
  • Fax: 402-330-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3006
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: