Provider Demographics
NPI:1700825932
Name:BATENHORST, MICHAEL G (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:BATENHORST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3456
Mailing Address - Country:US
Mailing Address - Phone:308-236-5884
Mailing Address - Fax:308-236-9621
Practice Address - Street 1:211 W 33RD ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3456
Practice Address - Country:US
Practice Address - Phone:308-236-5884
Practice Address - Fax:308-236-9621
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE95225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09188OtherBLUE CROSS BLUE SHIELD
NE47076931613Medicaid
NE47076931613Medicaid