Provider Demographics
NPI:1851426530
Name:FAMILY PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:FAMILY PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:PEETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, MTC
Authorized Official - Phone:402-333-8464
Mailing Address - Street 1:13911 GOLD CIR STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2376
Mailing Address - Country:US
Mailing Address - Phone:402-333-8464
Mailing Address - Fax:402-333-3138
Practice Address - Street 1:13911 GOLD CIR STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2376
Practice Address - Country:US
Practice Address - Phone:402-333-8464
Practice Address - Fax:402-333-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE091049Medicare ID - Type Unspecified