=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386851806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEWARD PHYSICAL THERAPY SERVICES P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 418 SEWARD ST
-----------------------------------------------------
City | SEWARD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68434-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-643-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 418 SEWARD ST
-----------------------------------------------------
City | SEWARD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68434-2129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-643-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GARY WAYNE POMERENKE
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 402-643-6111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 758
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------