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General NPI Number Information
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NPI Number | 1992339576
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Entity Type | Individual
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Provider Name | BLAKE OSTRANDER
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Gender | Male
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 6319 HAVELOCK AVE
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City | LINCOLN
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State | NE
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Zip | 68507-1328
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Country | US
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Telephone | 402-325-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 6319 HAVELOCK AVE
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City | LINCOLN
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State | NE
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Zip | 68507-1328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1483
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License Number State | NE
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