Healthcare Provider Details

I. General information

NPI: 1548884935
Provider Name (Legal Business Name): NEBRASKA PELVIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 S 140TH ST
OMAHA NE
68144-2339
US

IV. Provider business mailing address

2510 S 140TH ST
OMAHA NE
68144-2339
US

V. Phone/Fax

Practice location:
  • Phone: 402-618-3320
  • Fax: 402-913-3102
Mailing address:
  • Phone: 402-618-3320
  • Fax: 402-913-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIERRA RACHELLE LARSEN
Title or Position: OWNER, PHYSICAL THERAPIST
Credential:
Phone: 402-618-3320