Provider Demographics
NPI:1881830404
Name:MARIAN LORD, PHYSICAL THERAPIST, P.C.
Entity Type:Organization
Organization Name:MARIAN LORD, PHYSICAL THERAPIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-334-6213
Mailing Address - Street 1:14441 DUPONT CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2153
Mailing Address - Country:US
Mailing Address - Phone:402-334-6213
Mailing Address - Fax:402-334-6218
Practice Address - Street 1:14441 DUPONT CT
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2153
Practice Address - Country:US
Practice Address - Phone:402-334-6213
Practice Address - Fax:402-334-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE09205OtherBLUE CROSS
NEF247007OtherMIDLANDS CHOICE
NENA1244OtherMEDICARE PTAN
NENA1244OtherMEDICARE PTAN