Provider Demographics
NPI:1568444784
Name:MUCHOWICZ, NICHOLAS CHRISTOPHER (MPT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CHRISTOPHER
Last Name:MUCHOWICZ
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 1:11810 NICHOLAS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4453
Mailing Address - Country:US
Mailing Address - Phone:402-932-2888
Mailing Address - Fax:402-932-2899
Practice Address - Street 1:11810 NICHOLAS ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4453
Practice Address - Country:US
Practice Address - Phone:402-932-2888
Practice Address - Fax:402-932-2899
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025418400Medicaid
NE68154A020OtherTRICARE
NE02128OtherBCBS
NE241541OtherMIDLANDS CHOICE
NEP00367179OtherRAILROAD MEDICARE
NE10025418400Medicaid