Provider Demographics
NPI:1730474065
Name:VANCURA, SCOTT MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:VANCURA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2473
Mailing Address - Country:US
Mailing Address - Phone:402-564-5456
Mailing Address - Fax:402-562-6350
Practice Address - Street 1:3211 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2473
Practice Address - Country:US
Practice Address - Phone:402-564-5456
Practice Address - Fax:402-562-6350
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082077300Medicaid
NE098863004Medicare UPIN