Provider Demographics
NPI:1376503011
Name:BORNSCHLEGL, MATTHEW ERIC (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:BORNSCHLEGL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 CANYON CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5748
Mailing Address - Country:US
Mailing Address - Phone:402-420-6694
Mailing Address - Fax:
Practice Address - Street 1:4525 S 86TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9227
Practice Address - Country:US
Practice Address - Phone:402-420-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP28613Medicare UPIN
NE276210Medicare ID - Type Unspecified