Provider Demographics
NPI:1366452542
Name:RATHJEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:RATHJEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RATHJEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:308-381-2424
Mailing Address - Street 1:3213 W. NORTH FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4028
Mailing Address - Country:US
Mailing Address - Phone:308-381-2424
Mailing Address - Fax:308-381-3646
Practice Address - Street 1:3213 W. NORTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4028
Practice Address - Country:US
Practice Address - Phone:308-381-2424
Practice Address - Fax:308-381-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025243900Medicaid
099625Medicare PIN