=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174686240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI A LONGE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 555 S 70TH ST RM 2504
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-219-7498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8055 O ST STE 300
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68510-2580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-421-0896
-----------------------------------------------------
Fax | 402-421-0945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 1923
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------