Provider Demographics
NPI:1568837482
Name:LINCOLN ORTHOPEDIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LINCOLN ORTHOPEDIC PHYSICAL THERAPY PC
Other - Org Name:LINCOLN ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWAARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:402-484-7117
Mailing Address - Street 1:1651 N 86TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3719
Mailing Address - Country:US
Mailing Address - Phone:402-484-7117
Mailing Address - Fax:402-484-7118
Practice Address - Street 1:4920 N 26TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4748
Practice Address - Country:US
Practice Address - Phone:402-434-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINCOLN ORTHOPEDIC PHYSICAL THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies