Healthcare Provider Details

I. General information

NPI: 1811194624
Provider Name (Legal Business Name): OMAHA PHYSICAL THERAPY INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 144TH AVE SUITE 102
OMAHA NE
68154-0000
US

IV. Provider business mailing address

625 N 144TH AVE SUITE 102
OMAHA NE
68154-0000
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-8688
  • Fax: 402-934-8689
Mailing address:
  • Phone: 402-934-8688
  • Fax: 402-934-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2429
License Number StateNE

VIII. Authorized Official

Name: DR. BRENT HENRY CORDERY
Title or Position: PRESIDENT
Credential: DPT
Phone: 402-934-8688