Provider Demographics
NPI:1386851806
Name:SEWARD PHYSICAL THERAPY SERVICES P.C.
Entity Type:Organization
Organization Name:SEWARD PHYSICAL THERAPY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:POMERENKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-643-6111
Mailing Address - Street 1:418 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2129
Mailing Address - Country:US
Mailing Address - Phone:402-643-6111
Mailing Address - Fax:
Practice Address - Street 1:418 SEWARD ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2129
Practice Address - Country:US
Practice Address - Phone:402-643-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099633OtherPTAN