Provider Demographics
NPI:1821768763
Name:BOECKMAN, NATALIE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNN
Last Name:BOECKMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LYNN
Other - Last Name:STANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68349-0072
Mailing Address - Country:US
Mailing Address - Phone:402-297-3098
Mailing Address - Fax:
Practice Address - Street 1:213 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:NE
Practice Address - Zip Code:68349-6123
Practice Address - Country:US
Practice Address - Phone:402-297-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant