Provider Demographics
NPI:1437101102
Name:URBOM, CHRISTINE F (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:F
Last Name:URBOM
Suffix:
Gender:F
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:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-0789
Mailing Address - Country:US
Mailing Address - Phone:308-962-5403
Mailing Address - Fax:
Practice Address - Street 1:811 HOWELL ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NE
Practice Address - Zip Code:68967-6754
Practice Address - Country:US
Practice Address - Phone:308-962-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE-355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
39661OtherBLUE CROSS BLUE SHIELD
6400389OtherUNITED HEALTH CARE
F242251OtherMIDLANDS CHOICE
P00060541OtherRAILROAD MEDICARE
NE276514Medicare ID - Type Unspecified