Provider Demographics
NPI:1659742047
Name:C.O.R.E. PHYSICAL THERAPY AND SPORTS PERFORMANCE PC
Entity Type:Organization
Organization Name:C.O.R.E. PHYSICAL THERAPY AND SPORTS PERFORMANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RATHJEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-933-4027
Mailing Address - Street 1:17660 WRIGHT ST STE 9AND10
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2102
Mailing Address - Country:US
Mailing Address - Phone:402-933-4027
Mailing Address - Fax:402-933-5027
Practice Address - Street 1:17660 WRIGHT ST # ST910
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2102
Practice Address - Country:US
Practice Address - Phone:402-933-4027
Practice Address - Fax:402-933-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1578725677Medicare PIN