Provider Demographics
NPI:1033307558
Name:LIVE WELL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LIVE WELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:308-382-9700
Mailing Address - Street 1:929 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6751
Mailing Address - Country:US
Mailing Address - Phone:380-382-9700
Mailing Address - Fax:308-382-9898
Practice Address - Street 1:929 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6751
Practice Address - Country:US
Practice Address - Phone:380-382-9700
Practice Address - Fax:308-382-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1060261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy