MEDICARE: MR. JUSTIN A HASH 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	225100000X	Physical Therapist	2248	NE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00165975	OTHER	NE	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	39929	OTHER	NE	BCBS OF NEBRASKA

General Provider Information

NPI Number	:	1952417149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN A HASH PT

Provider Business Mailing Address
First Line	:	1305 S 70TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-4247
Country	:	US
Telephone Number	:	402-484-7162
Fax Number	:	402-488-4943

Provider Business Practice Location Address
First Line	:	1305 S 70TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-4247
Country	:	US
Telephone Number	:	402-484-7162
Fax Number	:	402-488-4943

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/29/2011

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