MEDICARE: DIVERSIFIED MOBILE PT LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225200000X	Physical Therapy Assistant
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist
4	224Z00000X	Occupational Therapy Assistant
5	225X00000X	Occupational Therapist
6	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1164289880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVERSIFIED MOBILE PT LLC

Provider Business Mailing Address
First Line	:	5114 N 137TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-6191
Country	:	US
Telephone Number	:	402-819-7956
Fax Number	:	531-201-6077

Provider Business Practice Location Address
First Line	:	5114 N 137TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-6191
Country	:	US
Telephone Number	:	402-819-7956
Fax Number	:	531-201-6077

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICOLE KRISTINE DICKMEYER
Credential	:	PT, DPT
Telephone Number	:	402-317-9120

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	05/15/2026

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Directions to “DIVERSIFIED MOBILE PT LLC ” Practice Location

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