MEDICARE: MR. JOSEPH MCCAIN PTA

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	225200000X	Physical Therapy Assistant	1498	NE

General Provider Information

NPI Number	:	1811445695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MCCAIN PTA

Provider Business Mailing Address
First Line	:	5030 R ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68504-4007
Country	:	US
Telephone Number	:	903-563-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 224TH
Second Line	:
City	:	MILFORD
State	:	NE
Zip	:	68405-8475
Country	:	US
Telephone Number	:	402-761-3230
Fax Number	:

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

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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Directions to “ MR. JOSEPH MCCAIN PTA” Practice Location

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