Healthcare Provider Details

I. General information

NPI: 1326210592
Provider Name (Legal Business Name): CREIGHTON UNIVERSITY MEDICAL CENTER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST
OMAHA NE
68131-2137
US

IV. Provider business mailing address

601 N 30TH ST
OMAHA NE
68131-2137
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4244
  • Fax: 402-449-5852
Mailing address:
  • Phone: 402-449-4244
  • Fax: 402-449-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number840
License Number StateNE

VIII. Authorized Official

Name: MS. DORINE KAY ROTH
Title or Position: STAFF PHYSICAL THERAPIST
Credential: PT
Phone: 402-449-4244