=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821113069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY JON HOWE P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N COLUMBIA AVE
-----------------------------------------------------
City | SEWARD
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68434-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-643-2971
-----------------------------------------------------
Fax | 402-646-4646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 435 N 44TH ST 1419
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68503-3756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-643-2971
-----------------------------------------------------
Fax | 402-646-4646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1244
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------