Provider Demographics
NPI:1164405155
Name:ANDERSON, BETSY A (PT)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 HELEN WITT DR SUITE A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3612
Mailing Address - Country:US
Mailing Address - Phone:402-420-4545
Mailing Address - Fax:402-423-0189
Practice Address - Street 1:559 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1280
Practice Address - Country:US
Practice Address - Phone:402-420-4545
Practice Address - Fax:402-420-0402
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist