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General NPI Number Information
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NPI Number | 1245323831
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Entity Type | Organization
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Legal Business Name | PT WEST PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 100 S MAIN
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City | GORDON
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State | NE
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Zip | 69343-1618
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Country | US
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Telephone | 308-282-0203
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Fax | 308-282-1276
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Provider Business Mailing Address
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Address Line | PO BOX 28 100 SOUTH MAIN
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City | GORDON
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State | NE
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Zip | 69343-1618
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Country | US
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Telephone | 308-282-0203
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Fax | 308-282-1276
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIMBERLY J MARLATT
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Credential | PT ATC
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Telephone | 308-282-0203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 651
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License Number State | NE
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