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General NPI Number Information
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NPI Number | 1366016230
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Entity Type | Organization
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Legal Business Name | PRIME PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 05/16/2021
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Last Update Date | 05/16/2021
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Provider Practice Location Address
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Address Line | 10456 CHANDLER CIR STE 103
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City | LA VISTA
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State | NE
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Zip | 68128-3257
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Country | US
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Telephone | 402-212-8971
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Fax | 401-201-2380
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Provider Business Mailing Address
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Address Line | 10456 CHANDLER CIR STE 103
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City | LA VISTA
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State | NE
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Zip | 68128-3257
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Country | US
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Telephone | 402-212-8971
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Fax | 401-201-2380
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NICOLE STAMM
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Credential | PT
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Telephone | 402-212-8971
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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 |
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License Number State |
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