Provider Demographics
NPI:1710239447
Name:EAST CENTRAL NEBRASKA THERAPY
Entity Type:Organization
Organization Name:EAST CENTRAL NEBRASKA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-652-8201
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-0211
Mailing Address - Country:US
Mailing Address - Phone:402-367-7728
Mailing Address - Fax:
Practice Address - Street 1:640 W 6TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-4430
Practice Address - Country:US
Practice Address - Phone:402-652-8201
Practice Address - Fax:402-652-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty