Provider Demographics
NPI:1366016230
Name:PRIME PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PRIME PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-212-8971
Mailing Address - Street 1:10456 CHANDLER CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3257
Mailing Address - Country:US
Mailing Address - Phone:402-212-8971
Mailing Address - Fax:401-201-2380
Practice Address - Street 1:10456 CHANDLER CIR STE 103
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3257
Practice Address - Country:US
Practice Address - Phone:402-212-8971
Practice Address - Fax:401-201-2380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty