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General NPI Number Information
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NPI Number | 1841246170
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Entity Type | Organization
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Legal Business Name | CRETE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 830 E 1ST ST
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City | CRETE
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State | NE
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Zip | 68333-3108
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Country | US
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Telephone | 402-826-2255
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Fax | 402-826-2288
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Provider Business Mailing Address
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Address Line | PO BOX 294
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City | CRETE
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State | NE
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Zip | 68333-0294
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Country | US
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Telephone | 402-826-2255
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KELLIE BLACKMON
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Credential |
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Telephone | 770-748-0309
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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