Provider Demographics
NPI:1619752698
Name:DEVAN PHYSIO LLC
Entity Type:Organization
Organization Name:DEVAN PHYSIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDLACEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-889-0166
Mailing Address - Street 1:13211 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1245
Mailing Address - Country:US
Mailing Address - Phone:402-889-0166
Mailing Address - Fax:
Practice Address - Street 1:13748 F ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1153
Practice Address - Country:US
Practice Address - Phone:402-889-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty