Provider Demographics
NPI:1407038375
Name:FAMILY PHYSICAL THERAPY & SPORTS CENTER
Entity Type:Organization
Organization Name:FAMILY PHYSICAL THERAPY & SPORTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-698-2820
Mailing Address - Street 1:615 W 39TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8001
Mailing Address - Country:US
Mailing Address - Phone:308-698-2820
Mailing Address - Fax:308-698-2822
Practice Address - Street 1:615 W 39TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8001
Practice Address - Country:US
Practice Address - Phone:308-698-2820
Practice Address - Fax:308-698-2822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY PHYSICAL THERAPY & SPORTS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========13Medicaid
NE=========13Medicaid