Provider Demographics
NPI:1811194624
Name:OMAHA PHYSICAL THERAPY INSTITUTE, PC
Entity Type:Organization
Organization Name:OMAHA PHYSICAL THERAPY INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CORDERY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:402-934-8688
Mailing Address - Street 1:625 N 144TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-0000
Mailing Address - Country:US
Mailing Address - Phone:402-934-8688
Mailing Address - Fax:402-934-8689
Practice Address - Street 1:625 N 144TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-0000
Practice Address - Country:US
Practice Address - Phone:402-934-8688
Practice Address - Fax:402-934-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2429261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy