Provider Demographics
NPI:1326382540
Name:URBOM, STEFANIE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNN
Last Name:URBOM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:LYNN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1501 PINE LAKE RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3636
Mailing Address - Country:US
Mailing Address - Phone:402-421-2700
Mailing Address - Fax:402-421-2699
Practice Address - Street 1:1501 PINE LAKE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3636
Practice Address - Country:US
Practice Address - Phone:402-421-2700
Practice Address - Fax:402-421-2699
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist