Provider Demographics
NPI:1508586538
Name:HOLDREGE PHYSICAL THERAPY AND SPORTS REHAB
Entity Type:Organization
Organization Name:HOLDREGE PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:308-248-0303
Mailing Address - Street 1:701 4TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2255
Mailing Address - Country:US
Mailing Address - Phone:308-248-0303
Mailing Address - Fax:308-248-0304
Practice Address - Street 1:701 4TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2255
Practice Address - Country:US
Practice Address - Phone:308-248-0303
Practice Address - Fax:308-248-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty