Healthcare Provider Details

I. General information

NPI: 1447315858
Provider Name (Legal Business Name): WILDCAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST
WAYNE NE
68787-1923
US

IV. Provider business mailing address

PO BOX 681478
FRANKLIN TN
37068-1478
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-7310
  • Fax: 402-375-7572
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: REGG SWANSON
Title or Position: PARTNER
Credential:
Phone: 615-591-6590