Healthcare Provider Details

I. General information

NPI: 1417968645
Provider Name (Legal Business Name): PACIFIC SPRINGS PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 S 178TH STREET
OMAHA NE
68118
US

IV. Provider business mailing address

7123 N 121ST ST
OMAHA NE
68142-1675
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-3036
  • Fax:
Mailing address:
  • Phone: 402-201-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1964
License Number StateNE

VIII. Authorized Official

Name: MISS KRISIT MARIE HEINE
Title or Position: OWNER
Credential: MSPT
Phone: 402-933-3036