=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982997573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCMEEN PHYSICAL THERAPY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2011
-----------------------------------------------------
Last Update Date | 05/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E OCONNOR AVE
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68842-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-428-5111
-----------------------------------------------------
Fax | 308-428-5111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 S 1ST AVE
-----------------------------------------------------
City | BROKEN BOW
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68822-2213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-872-5111
-----------------------------------------------------
Fax | 308-872-5115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PT
-----------------------------------------------------
Name | JEFFREY MCMEEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-872-5111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------