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General NPI Number Information
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NPI Number | 1306538863
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Entity Type | Individual
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Provider Name | MICAH KOHLWEY DPT
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Gender | Male
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 5401 SOUTH ST
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City | LINCOLN
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State | NE
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Zip | 68506-2150
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Country | US
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Telephone | 402-413-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 W BIG SKY RD
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City | LINCOLN
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State | NE
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Zip | 68521-1317
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Country | US
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Telephone | 402-641-1451
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 101422
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4528
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License Number State | NE
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