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NPI Code Detail

MEDICARE: AMANDA GALE HEERMANS PT

MEDICARE:   AMANDA GALE HEERMANS  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
1225100000XPhysical TherapistP4755NC
22251C2600XCardiopulmonary Physical TherapistP4755NC
32251G0304XGeriatric Physical TherapistP4755NC
42251N0400XNeurology Physical TherapistP4755NC

General Provider Information

NPI Number : 1972950988
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA GALE HEERMANS PT
Provider Business Mailing Address
First Line : 13609 CALIFORNIA ST
Second Line : SUITE 200
City : OMAHA
State : NE
Zip : 68154-5260
Country : US
Telephone Number : 402-891-1118
Fax Number : 402-895-7812
Provider Business Practice Location Address
First Line : 13609 CALIFORNIA ST
Second Line : SUITE 200
City : OMAHA
State : NE
Zip : 68154-5260
Country : US
Telephone Number : 402-891-1118
Fax Number : 402-895-7812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2016
Last Update Date : 05/19/2016

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