Healthcare Provider Details

I. General information

NPI: 1205750718
Provider Name (Legal Business Name): STEFANIE LARSEN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S 144TH ST
OMAHA NE
68144-5243
US

IV. Provider business mailing address

21025 W CIR
ELKHORN NE
68022-3128
US

V. Phone/Fax

Practice location:
  • Phone: 402-609-3000
  • Fax:
Mailing address:
  • Phone: 402-689-3840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1573
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: