Provider Demographics
NPI:1801820840
Name:LINE, STEVEN LYLE (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LYLE
Last Name:LINE
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 1:3211 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:402-564-9569
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:68601-1309
Practice Address - Country:US
Practice Address - Phone:402-564-5456
Practice Address - Fax:402-562-6350
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-082077300Medicaid
NE36566OtherBLUE CROSS BLUE SHIELD
NE36566OtherBLUE CROSS BLUE SHIELD