Provider Demographics
NPI:1164670196
Name:CREIGHTON UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:CREIGHTON UNIVERSITY MEDICAL CENTER
Other - Org Name:TWIN CREEKS PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:R
Authorized Official - Last Name:PLUMB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-449-5800
Mailing Address - Street 1:3802 RAYNOR PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-2528
Mailing Address - Country:US
Mailing Address - Phone:402-449-5800
Mailing Address - Fax:
Practice Address - Street 1:3802 RAYNOR PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-2528
Practice Address - Country:US
Practice Address - Phone:402-449-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMC PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2670261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center