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NPI Code Detail

MEDICARE: NICHOLAS GRAEVE DPT

MEDICARE: NICHOLAS GRAEVE DPT
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
1225100000XPhysical Therapist3103NE

General Provider Information

NPI Number : 1629333992
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS GRAEVE DPT
Provider Business Mailing Address
First Line : 17438 WASHINGTON ST
Second Line :
City : OMAHA
State : NE
Zip : 68135-3202
Country : US
Telephone Number : 402-319-5281
Fax Number :
Provider Business Practice Location Address
First Line : 20800 W MAPLE RD
Second Line :
City : ELKHORN
State : NE
Zip : 68022-5108
Country : US
Telephone Number : 402-319-5281
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2012
Last Update Date : 03/24/2017

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Directions to “ NICHOLAS GRAEVE DPT” Practice Location

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