Provider Demographics
NPI:1053512681
Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Entity Type:Organization
Organization Name:LINCOLN PHYSICAL THERAPY AND SPORTS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHMHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-421-2700
Mailing Address - Street 1:1501 PINE LAKE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3692
Mailing Address - Country:US
Mailing Address - Phone:402-421-2700
Mailing Address - Fax:402-421-2699
Practice Address - Street 1:6940 VAN DORN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2858
Practice Address - Country:US
Practice Address - Phone:402-483-4709
Practice Address - Fax:402-483-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE091028Medicare PIN