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General NPI Number Information
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NPI Number | 1174868145
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 47581 815TH RD
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City | ORD
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State | NE
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Zip | 68862-5362
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Country | US
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Telephone | 308-728-4070
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Fax | 866-411-4048
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Provider Business Mailing Address
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Address Line | 47581 815TH RD
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City | ORD
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State | NE
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Zip | 68862-5362
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Country | US
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Telephone | 308-728-4070
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Fax | 866-411-4048
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. CHRISTY PETERSON
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Credential | PT
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Telephone | 308-727-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 670
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License Number State | NE
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