MEDICARE: CAITLIN ELAINE SEACREST LMT

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	225100000X	Physical Therapist	2129	NE

General Provider Information

NPI Number	:	1588159081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ELAINE SEACREST LMT

Provider Business Mailing Address
First Line	:	3601 CALVERT ST STE 27
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-5797
Country	:	US
Telephone Number	:	531-207-5776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 CALVERT ST STE 27
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-5797
Country	:	US
Telephone Number	:	531-207-5776
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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