=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548884935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEBRASKA PELVIC THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2020
-----------------------------------------------------
Last Update Date | 07/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2510 S 140TH ST
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-618-3320
-----------------------------------------------------
Fax | 402-913-3102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2510 S 140TH ST
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68144-2339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-618-3320
-----------------------------------------------------
Fax | 402-913-3102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, PHYSICAL THERAPIST
-----------------------------------------------------
Name | KIERRA RACHELLE LARSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-618-3320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------