Provider Demographics
NPI:1164013116
Name:KOHOUT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:KOHOUT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KOHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, SCS
Authorized Official - Phone:402-469-3634
Mailing Address - Street 1:811 S COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-4009
Mailing Address - Country:US
Mailing Address - Phone:402-469-3634
Mailing Address - Fax:
Practice Address - Street 1:115 E. 4TH STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467
Practice Address - Country:US
Practice Address - Phone:402-745-6399
Practice Address - Fax:402-745-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025822500Medicaid