Provider Demographics
NPI:1093906034
Name:MORAVEC, MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MORAVEC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 AVENUE B
Mailing Address - Street 2:SUITE A
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-1763
Mailing Address - Country:US
Mailing Address - Phone:308-633-7878
Mailing Address - Fax:308-633-5365
Practice Address - Street 1:2970 10TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1763
Practice Address - Country:US
Practice Address - Phone:308-633-5361
Practice Address - Fax:308-633-5365
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026734200Medicaid