Provider Demographics
NPI:1275737322
Name:NANNEN PHYSICAL THERAPY AND PERSONAL TRAINING
Entity Type:Organization
Organization Name:NANNEN PHYSICAL THERAPY AND PERSONAL TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:NANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:402-426-3488
Mailing Address - Street 1:636 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1116
Mailing Address - Country:US
Mailing Address - Phone:402-426-3488
Mailing Address - Fax:402-426-3553
Practice Address - Street 1:636 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1116
Practice Address - Country:US
Practice Address - Phone:402-426-3488
Practice Address - Fax:402-426-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47036333032Medicaid
NE47036333032Medicaid