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General NPI Number Information
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NPI Number | 1013031285
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Entity Type | Organization
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Legal Business Name | STODDEN PHYSICAL THERAPY,LLC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 11532 WILLOW PARK DR SU 100
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City | GRETNA
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State | NE
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Zip | 68028-6947
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Country | US
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Telephone | 402-289-5013
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Fax | 402-289-5018
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Provider Business Mailing Address
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Address Line | 1405 N 205TH ST STODDEN PHYSICAL THERAPY,LLC SU 140
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City | ELKHORN
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State | NE
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Zip | 68022-4740
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Country | US
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Telephone | 402-289-5013
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Fax | 402-289-5018
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE STODDEN
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Credential | PT
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Telephone | 402-289-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1604
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License Number State | NE
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