Provider Demographics
NPI:1578595625
Name:TEAM PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:TEAM PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS & PERSONNEL
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:308-872-5111
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-0435
Mailing Address - Country:US
Mailing Address - Phone:308-872-5111
Mailing Address - Fax:308-872-5115
Practice Address - Street 1:325 SOUTH 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2331
Practice Address - Country:US
Practice Address - Phone:308-872-5111
Practice Address - Fax:308-872-5115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEAM PHYSICAL THERAPY, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0926650001Medicare NSC
NE098562Medicare ID - Type UnspecifiedGROUP