Provider Demographics
NPI:1649219627
Name:PHYSICAL THERAPY CENTER PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-466-7030
Mailing Address - Street 1:600 N COTNER BLVD
Mailing Address - Street 2:LINCOLN
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-466-7030
Mailing Address - Fax:402-466-6693
Practice Address - Street 1:600 N COTNER BLVD
Practice Address - Street 2:LINCOLN
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-466-7030
Practice Address - Fax:402-466-6693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========32Medicaid
NE099062Medicare ID - Type Unspecified