=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013441807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREMONT THERAPY & WELLNESS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2017
-----------------------------------------------------
Last Update Date | 03/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 N BELL ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-512-3893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 N BELL ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-5205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-512-3893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | RENE SCHNOOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-512-3893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 1791
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------