Provider Demographics
NPI:1417968645
Name:PACIFIC SPRINGS PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PACIFIC SPRINGS PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISIT
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:402-933-3036
Mailing Address - Street 1:7123 N 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1675
Mailing Address - Country:US
Mailing Address - Phone:402-201-3707
Mailing Address - Fax:
Practice Address - Street 1:1021 S 178TH STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-933-3036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19642251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty