Provider Demographics
NPI:1487636601
Name:OLDEHOEFT, ADAM JOHN (MPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOHN
Last Name:OLDEHOEFT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20758 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-4509
Mailing Address - Country:US
Mailing Address - Phone:402-827-0987
Mailing Address - Fax:
Practice Address - Street 1:20758 AMES AVE
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4509
Practice Address - Country:US
Practice Address - Phone:402-827-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2586396Medicaid
IA0586396Medicaid
IA0586396Medicaid
NE275954Medicare ID - Type UnspecifiedMEDICARE NUMBER
NE39845OtherBLUE CROSS BLUE SHIELD