Provider Demographics
NPI:1073579819
Name:ELKHORN PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ELKHORN PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-289-3288
Mailing Address - Street 1:20289 WIRT STREET
Mailing Address - Street 2:PO BOX 177
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-1417
Mailing Address - Country:US
Mailing Address - Phone:402-289-3288
Mailing Address - Fax:402-289-2550
Practice Address - Street 1:20289 WIRT ST.
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1417
Practice Address - Country:US
Practice Address - Phone:402-289-3288
Practice Address - Fax:402-289-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE02067OtherBCBS
39576OtherBCBS
NE02067OtherBCBS
NE02067OtherBCBS
NER81565Medicare UPIN