Provider Demographics
NPI:1528407871
Name:WRENHOLT, TIM WILLIAM (PT)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:WILLIAM
Last Name:WRENHOLT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S 85TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9231
Mailing Address - Country:US
Mailing Address - Phone:402-423-7328
Mailing Address - Fax:
Practice Address - Street 1:5900 S 85TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9231
Practice Address - Country:US
Practice Address - Phone:402-423-7328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31102251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic