Healthcare Provider Details

I. General information

NPI: 1306911433
Provider Name (Legal Business Name): DAVID H. POTACH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 W CENTER RD SUITE 525
OMAHA NE
68144-3969
US

IV. Provider business mailing address

12100 W CENTER RD SUITE 525
OMAHA NE
68144-3969
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-2774
  • Fax: 402-330-2779
Mailing address:
  • Phone: 402-330-2774
  • Fax: 402-330-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1765
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: