MEDICARE: DR. JUSTIN L BLATCHFORD PT

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	2251P0200X	Pediatric Physical Therapist	3881	NE
2	225100000X	Physical Therapist	3881	NE
3	2251X0800X	Orthopedic Physical Therapist	3881	NE

General Provider Information

NPI Number	:	1356820989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN L BLATCHFORD PT

Provider Business Mailing Address
First Line	:	10118 MAPLE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-5555
Country	:	US
Telephone Number	:	402-939-7939
Fax Number	:	402-939-7940

Provider Business Practice Location Address
First Line	:	20502 ROOSEVELT ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4148
Country	:	US
Telephone Number	:	402-955-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	01/12/2026

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