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General NPI Number Information
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NPI Number | 1639568116
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Entity Type | Organization
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Legal Business Name | HEARTLAND EQUINE THERAPEUTIC RIDING ACADEMY INC.
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 10130 S 222ND ST
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City | GRETNA
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State | NE
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Zip | 68028-4317
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Country | US
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Telephone | 402-359-8830
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Fax |
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Provider Business Mailing Address
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Address Line | 10130 S 222ND ST
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City | GRETNA
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State | NE
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Zip | 68028-4317
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Country | US
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Telephone | 402-359-8830
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | EDYE GODDEN
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Credential | OTR/L
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Telephone | 402-359-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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