MEDICARE: NORFOLK PHYSCIAL THERAPY

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	883	NE

General Provider Information

NPI Number	:	1326475781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK PHYSCIAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 448
Second Line	:
City	:	HUMPHREY
State	:	NE
Zip	:	68642-0448
Country	:	US
Telephone Number	:	402-640-0083
Fax Number	:

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

Authorized Official
Title or Position	:	DPT
Name	:	DOUG JUNGE
Credential	:
Telephone Number	:	402-371-9707

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	10/01/2013

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