Healthcare Provider Details

I. General information

NPI: 1184392730
Provider Name (Legal Business Name): ANGELA R PEREIRA-BURBACH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

PO BOX 24607
OMAHA NE
68124-0607
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-3980
  • Fax: 402-955-5368
Mailing address:
  • Phone: 402-955-5400
  • Fax: 402-955-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4264
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: