Healthcare Provider Details

I. General information

NPI: 1730019985
Provider Name (Legal Business Name): TREVOR SAMUEL BANDIERA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 N 114TH ST
OMAHA NE
68154-2517
US

IV. Provider business mailing address

360 N 114TH ST
OMAHA NE
68154-2517
US

V. Phone/Fax

Practice location:
  • Phone: 402-740-8400
  • Fax: 402-547-4200
Mailing address:
  • Phone: 402-740-8400
  • Fax: 402-547-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4880
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: