MEDICARE: NORFOLK PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	1147	NE

General Provider Information

NPI Number	:	1063784346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	1220 W BENJAMIN AVE
Second Line	:	SUITE 4
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:	402-371-9719

Provider Business Practice Location Address
First Line	:	1220 W BENJAMIN AVE
Second Line	:	SUITE 4
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:	402-371-9719

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS JUNGE
Credential	:	PT
Telephone Number	:	402-371-9707

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	02/02/2012

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