Healthcare Provider Details

I. General information

NPI: 1649180340
Provider Name (Legal Business Name): ZACHARY ROTERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 S 136TH ST
OMAHA NE
68144-1102
US

IV. Provider business mailing address

1622 HOLLING DR
OMAHA NE
68144-1219
US

V. Phone/Fax

Practice location:
  • Phone: 308-293-9500
  • Fax:
Mailing address:
  • Phone: 402-957-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: