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General NPI Number Information
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NPI Number | 1053247684
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Entity Type | Individual
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Provider Name | MIRELLA A GATTERDAM DPT
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Gender | Female
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Dates
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Enumeration Date | 06/22/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 20502 ROOSEVELT ST
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City | ELKHORN
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State | NE
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Zip | 68022-4148
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Country | US
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Telephone | 402-955-8000
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Fax | 402-955-8001
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Provider Business Mailing Address
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Address Line | PO BOX 24607
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City | OMAHA
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State | NE
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Zip | 68124-0607
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Country | US
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Telephone | 402-955-5400
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Fax | 402-955-3674
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 4979
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License Number State | NE
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