Healthcare Provider Details

I. General information

NPI: 1447580006
Provider Name (Legal Business Name): MCMY PT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N NEBRASKA AVE
YORK NE
68467-8096
US

IV. Provider business mailing address

9515 PINE CREST RD
BLAIR NE
68008-6580
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-2929
  • Fax: 402-362-3133
Mailing address:
  • Phone: 402-216-9329
  • Fax: 402-933-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2017
License Number StateNE

VIII. Authorized Official

Name: MR. RYAN MICHAEL MCCABE
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: P.T.
Phone: 402-216-9329