WEINHOLD, NICOLE J (PT)

Provider Demographics

• NPI: 1467526491
• Name: WEINHOLD, NICOLE J (PT)
• Entity Type: Individual
• First Name: NICOLE
• Middle Name: J
• Last Name: WEINHOLD
• Gender: F
• Credentials: PT
• Other - First Name: NICOLE
• Other - Middle Name: J
• Other - Last Name: KOCH
• Other - Last Name Type: Former Name
• Other - Credentials: PT
• Mailing Address - Street 1: 2705 SAMSON WAY
• Mailing Address - City: BELLEVUE
• Mailing Address - State: NE
• Mailing Address - Zip Code: 68123-4307
• Mailing Address - Country: US
• Mailing Address - Phone: 402-331-6387
• Mailing Address - Fax: 402-331-6537
• Practice Address - Street 1: 10780 V ST
• Practice Address - City: OMAHA
• Practice Address - State: NE
• Practice Address - Zip Code: 68127-2952
• Practice Address - Country: US
• Practice Address - Phone: 402-991-8999
• Practice Address - Fax: 402-991-6766
• Is Sole Proprietor?: No
• Enumeration Date: 2006-11-20
• Last Update Date: 2011-05-05

Provider Licenses

State	License ID	Taxonomies
NE	2028	225100000X, 2251X0800X, 2251S0007X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist
No	2251X0800X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist	Orthopedic
No	2251S0007X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist	Sports

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	10025518200	Medicaid
NE	10025518000	Medicaid
NE	1467526491	Other	INDIVIDUAL NPI #
NE	1548481187	Other	GROUP NPI
NE	10025518100	Medicaid
NE	5607210002	Medicare NSC
NE	1467526491	Other	INDIVIDUAL NPI #
NE	5607210001	Medicare NSC
NE	5607210004	Medicare NSC
NE	099583	Medicare PIN
NE	1548481187	Other	GROUP NPI
NE	277625	Medicare PIN