Healthcare Provider Details

I. General information

NPI: 1467526491
Provider Name (Legal Business Name): NICOLE J. WEINHOLD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE J KOCH P.T.

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11336 S 96TH ST STE 114
PAPILLION NE
68046-4211
US

IV. Provider business mailing address

11336 S 96TH ST STE 114
PAPILLION NE
68046-4211
US

V. Phone/Fax

Practice location:
  • Phone: 402-315-3603
  • Fax: 402-315-3604
Mailing address:
  • Phone: 402-315-3603
  • Fax: 402-315-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2028
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2028
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2028
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: