Healthcare Provider Details

I. General information

NPI: 1164289880
Provider Name (Legal Business Name): DIVERSIFIED MOBILE PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 N 137TH ST
OMAHA NE
68164-6191
US

IV. Provider business mailing address

5114 N 137TH ST
OMAHA NE
68164-6191
US

V. Phone/Fax

Practice location:
  • Phone: 402-819-7956
  • Fax: 531-201-6077
Mailing address:
  • Phone: 402-819-7956
  • Fax: 531-201-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE KRISTINE DICKMEYER
Title or Position: OWNER
Credential: PT, DPT
Phone: 402-317-9120