=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740503739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CODDINGTON PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2010
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 S CODDINGTON AVE SUITE C
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68522-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-423-0303
-----------------------------------------------------
Fax | 402-423-0202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1550 S CODDINGTON AVE STE C
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68522-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-423-0303
-----------------------------------------------------
Fax | 402-423-0202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. CASEY JONATHAN MOELLER
-----------------------------------------------------
Credential | D.P.T. B.S.
-----------------------------------------------------
Telephone | 402-826-2255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------